Pain Killer Medications

Introduction to Pain Management

The World Health Organization (WHO) recommends a stepwise approach to pain management, with non-opioid analgesics for mild pain, weak opioids for moderate pain, and strong opioids for moderate to severe pain, according to the WHO analgesic ladder 1, 2

Acetaminophen is recommended as first-line treatment for mild to moderate pain at doses of 1g every 4-6 hours (maximum 4g/day) by the American Pain Society, use cautiously in patients with liver failure 1, 3
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are particularly effective for inflammatory pain, especially bone pain, with common options including ibuprofen, ketoprofen, diclofenac, naproxen, as suggested by the European Society for Medical Oncology 1, 4, 5
NSAIDs should be used with caution due to potential gastrointestinal, renal, and cardiovascular side effects, as warned by the American Heart Association 6

Codeine is often combined with acetaminophen and requires monitoring for constipation, as recommended by the National Comprehensive Cancer Network 1, 5
Tramadol is effective for moderate pain but should be used with caution in patients with epilepsy risk or those taking antidepressants, according to the American Academy of Neurology 1, 7

Morphine is the first-line choice for moderate to severe pain, available in immediate and sustained-release formulations, as recommended by the European Association for Palliative Care 1, 8
Oxycodone is approximately 1.5-2 times as potent as oral morphine, as stated by the American College of Clinical Pharmacy 9
Hydromorphone is an effective alternative to oral morphine, as suggested by the American Society of Clinical Oncology 2

Antidepressants, including tricyclic antidepressants (TCAs), SSRIs, and SNRIs, can enhance monoaminergic neurotransmission and are used for neuropathic pain, as recommended by the International Association for the Study of Pain 6
Anticonvulsants, such as gabapentin and pregabalin, are first-line for neuropathic pain, working by binding to calcium channels, as suggested by the American Academy of Neurology 6

For moderate pain, add weak opioids (codeine, tramadol) or low-dose strong opioids if non-opioids are insufficient, as recommended by the National Institute for Health and Care Excellence 1, 5
For severe pain, use strong opioids, preferably starting with oral morphine unless urgent relief is needed, as suggested by the European Society for Medical Oncology 2, 4
For breakthrough pain, provide immediate-release formulations at approximately 10% of the total daily opioid dose, as recommended by the American Pain Society 9

Multimodal analgesia combining different medication classes can improve pain control while reducing side effects of individual drugs, as suggested by the World Health Organization 3
Regular administration rather than "as needed" dosing is recommended for chronic pain, as stated by the American Academy of Pain Medicine 2
Oral route should be preferred when possible, as recommended by the European Association for Palliative Care 2
In renal impairment, all opioids should be used with caution at reduced doses; fentanyl and buprenorphine are safer choices in advanced kidney disease, as suggested by the National Kidney Foundation 2