Introduction
There are several categories of pain relievers; one can specify three of them, and several are present in the infographic below.
Non-steroid anti-inflammatory drugs (NSAIDs), prominent examples are ketoprofen, ibuprofen, and aspirin. Most of them are also OTC drugs, so one can easily acquire them without a prescription. They show moderate adverse effects if used in large doses, suppressing emotions and reducing cognitive functions (Ratner et al., 2018). Opioid drugs are much more potent: as one will see below, they act on all levels of pain transmission, blocking it. They are dangerous, causing severe addiction; many people switch to heroin after using prescribed drugs due to the euphoria and intense pain relief it causes (Cicero, 2017). Local anesthetics, such as lidocaine, are used mostly as gels or sprays and reduce pain in specific parts of the organism. They are helpful during bruises and other injuries and are primarily available without prescriptions (Bahar & Yoon, 2021).
Main body
NSAIDs act mainly on the sites where pain impulses start, reducing inflammation and relieving the pain (Ratner et al., 2018). Local anesthetics, administered in the trauma’s place, block the pain transmission from the site to the brain (Bahar & Yoon, 2021). Opioids and other strong pain relievers, such as NMDA antagonists (ketamine), block pain transmission on various levels, including directly in the brain (Koepke et al., 2018; Kokane et al., 2020). WHO recommends three pain stages: during the first stage, non-opioid anesthetics, such as NSAIDs, are to be prescribed. More severe second and third stages require opioids, from weak codeine to potent fentanyl, and adjuvant drugs, such as ketamine.
There are various routes of drug administration, depending on the mechanism of action (Puntillo et al., 2021). They can be divided into enteral (oral, including buccal, and rectal), parenteral (intravenous, intramuscular, and other injections), topical (such as epidermic), and inhalation, such as intranasal. The table below shows how various opioid and NSAID drugs are administered. For example, ketamine is mostly prescribed against depression and post-traumatic disorders and is efficient in reducing psychological pain (Kokane et al., 2020). Lidocaine, having few side effects, except allergenic, helps relieve local pain (Bahar & Yoon, 2021)
Opioids are the most dangerous of all mentioned drugs, as their abuse leads to addiction and the risk of sudden death. While they reduce pain much more efficiently than other types, such as NSAIDs or ketamine, they cause addiction and have many severe side effects (Koepke et al., 2018). Examples are respiratory disorders, depression and other mental issues, and nausea (Zhao et al., 2019). Opioid mortality growth is very high, as seen on the graph and infographics. Anesthesiologists and drug prescribers can control the growth by using opioid replacement, such as ketamine (Koepke et al., 2018). Considering the risk factor groups, physicians can limit opioids for those patients who are in the risk group (Cragg et al., 2019)
Pain relievers users and risk groups
Prescribing Laws and Their Efficiency According to Cragg et al. (2019), there are specific groups of risk; in general, the younger and wealthier a patient, the greater the risk. Lists of them are available and can be used by physicians to estimate opioid usage risks.
Prescribing Laws and Their Efficiency
According to Davis et al. (2019), laws limiting opioid prescription, adopted in several U.S. states, had little or no effect on drug usage, despite the general usage lowering. Therefore, the legal approach should be focused on harm reduction and treatment availability rather than imposing new limitations.
Conclusion
Therefore, the most important insights from this infographic are the next ones:
- Substance disorder is the actual problem among painkiller drugs, especially opioids. Laws limiting opioid prescription are usually inefficient, as the reduction of opioid usage is almost not associated with them (Davis et al., 2019). Opioid drugs are the riskiest painkiller drugs, much riskier than ketamine and NSAIDs. Therefore, opioids must be prescribed only when other strong drugs, such as ketamine or lidocaine, cannot help (Koepke et al., 2018). There are various groups of risks that physicians can use to evaluate whether it is dangerous to prescribe opioids. For example, white men under age 40, married, employed, and educated, have much greater chances of becoming addicted (Cragg et al., 2019). OTC drugs cause various side effects as well, including emotional and cognitive suppression; however, they are much weaker than those caused by opioids and are present only when administered in high doses (Ratner et al., 2018).
- Recommendations for the anesthesiologists and prescribers include a more precise analysis of risk groups and factors and limiting the opioid prescriptions when other options are available, such as lidocaine and ketamine. For policymakers, it would be better to focus on laws that increase the treatment available for everyone at risk of drug abuse rather than threaten them with punishments.
References
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