What is an analgesic?

What types of analgesics are there?

Analgesics can be divided into different categories. Possible categorisations include according to potency, site of action and chemical structure.

‍

‍

Analgesics by potency

Analgesics are used to treat various types of pain. This includes acute pain, such as headaches caused by a cold, but also chronic pain. Pain that would occur during surgery, for example, is also treated with analgesics.

There are analgesics of different strengths depending on their area of application. A distinction is made between

• Weakly effective analgesics (e.g. paracetamol, ibuprofen)
• Weakly or low-potency centrally acting analgesics (e.g. codeine, tramadol)
• Strong or high-potency centrally acting analgesics (e.g. morphine, oxycodone)

‍

‍

Analgesics by site of action

Analgesics can act in different ways in the body. This is also referred to as analgesic effect. Depending on whether analgesics act at the site where the pain arises or in the central nervous system, a distinction is made between peripherally and centrally acting analgesics.

‍

Peripherally acting analgesics

Peripherally acting analgesics prevent the development of pain at the site where it arises. They work by inhibiting cyclooxygenase, an enzyme that influences the mediation of pain. Peripherally active analgesics often also have an antipyretic and sometimes anti-inflammatory effect. The most common peripherally acting analgesics include the active ingredients acetylsalicylic acid, paracetamol, diclofenac and ibuprofen.

‍

Centrally acting analgesics

Centrally acting analgesics act on the nerve cell structures in the central nervous system that are responsible for the perception of pain. They act by binding to specific receptors.

Centrally acting analgesics are divided into weakly and strongly acting analgesics.

Analgesics with a weak central effect include low-potency opiates or opioids such as codeine, tramadol or tilidine. Strongly centrally acting analgesics are highly potent opiates or opioids such as buprenorphine, morphine, oxycodone, hydromorphone or levomethadone.

‍

‍

Analgesics by chemical structure

Analgesics consist of different molecular structures. Accordingly, there are differences in how they are structured and how they exert their effect in the body.

‍

Non-opioid analgesics

Non-opioid analgesics are primarily used for pain, fever and inflammation. These include orthopaedic rheumatic complaints, post-operative/traumatic complaints, acute gout attacks, gynaecological pain, inflammatory infections and migraines.

They are often categorised into three groups according to their biochemical properties and their effect on the body:

• Acidic antipyretic-antiphlogistic analgesics (e.g. acetylsalicylic acid, ibuprofen, diclofenac, naproxen)
• Non-acidic antipyretic analgesics (e.g. paracetamol, metamizole, phenazone, propyphenazone, parecoxib, celecoxib, etoricoxib)
• Analgesics without antipyretic-antiphlogistic effect (e.g. ketamine, capsaicin, ziconotide, cannabinoids)

‍

Opioid analgesics

Opioid analgesics, also known as opioid analgesics, are used to treat acute and chronic pain and for sedation in anaesthesia.

A distinction is made between opioids and opiates.

Opioids are all substances with a morphine-like effect. They can be synthetic or obtained naturally from the milky sap of the opium poppy. Opiates contain only the alkaloids found in opium. Opiates are extracted from the milky sap of the opium poppy.

Opioids are considered to be the strongest painkillers available. They include codeine, fentanyl, methadone, morphine, tramal, tilidine, oxycodone and heroin.

Although opioids are an important part of pain therapy, especially for severe and chronic pain, they can also lead to the development of tolerance and dependence.

Therefore, careful medical supervision of pain therapy with opioids is essential to minimise the risks of long-term use and ensure safe treatment.

‍

‍

Which painkiller is best?

Pain is subjective and individual. It differs in the type or cause of the pain as well as in intensity and duration.

Which analgesic is most suitable for treating individual pain depends on the type of pain. As analgesics have different effects and are associated with different contraindications and side effects, the patient's medical history and state of health also play an important role.

For this reason, pain, especially pain that lasts longer or is very severe, should be discussed with a doctor. It can be helpful to document pain in detail, for example in a pain diary or in the Fimo Health app.

The treating doctor can then make a holistic assessment of which analgesic is best suited to the individual symptoms.