Pharmacologic Management of Pain - Pharmacology

Pharmacologic management of pain involves administering pain medication to relieve the patient’s pain. These include non-narcotic analgesics, nonsterioidal anti-inflammatory drugs (NSAIDs), narcotic analgesics, and salicylates.

Non-narcotic analgesics (see chart) are used to treat mild to moderate pain. Many of these medications are not addictive and available over-the-counter. Non-narcotic analgesics are used to treat headaches, menstrual pain (dysmenor-rheal), pain from inflammation, minor abrasions, muscular aches and pain, and mild-to-moderate arthritis. Non-narcotic analgesics also lower elevated body temperature (antipyretic). Non-narcotic analgesics include acetaminophen and NSAIDs (aspirin, ibuprofen, and COX-2 inhibitors), which were discussed in Inflammation.


Narcotic analgesics are known as narcotic agonists, and act on the central nervous system to provide relief from moderate and severe pain. Narcotic analgesics are also used to suppress coughing by acting on the respiratory and cough centers in the medulla of the brain stem.

Opioids are a category of narcotic analgesics. All relieve pain and all, except meperidine (Demerol), have an antitussive (cough suppression) and antidiar-rheal effect.


A narcotic agonist-antagonist (agonist) is an opioid narcotic mixed with nal-oxione (antagonist) to try to curb a form of drug misuse. Although the exact mechanism of action is unknown, these agents have both agonist and antagonist effects on the opioid receptors. Generally, these drugs are less potent and have a

other narcotic analgesics of the opium and synthetic group

lower dependency potential than opioids and withdrawal symptoms are not as severe. Commonly used narcotic agonist-antagonists are Pentazocine (Talwin), Butorphanol tartrate (Stadol), duprenorphine (Buprenex), and nalbuphine hydrochloride (Nubain). Their pharmacokinetics, adverse, and side effects are similar to morphine.


Narcotic antagonists (see chart) are antidotes for overdoses of narcotic analgesics. They have a higher affinity to the opiate receptor site than the narcotic analgesic and block the narcotic analgesic from binding to the opiate receptor site. They also reverse the respiratory and CNS depression caused by the narcotics.

Naloxone (Narcan) is a narcotic antagonist and can be used to determine if an unconscious patient has used an opioid narcotic drug. If the patient wakes up after Narcan is administered intravenously, the patient is likely to have ingested or injected an opioid narcotic.

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