Week 9: Lesson 9. Narcotic analgesics introduction and classification

Management of pain is one of clinical medicine’s greatest challenges. Pain is defined as an unpleasant sensation that can be either acute or chronic and is a consequence of complex neurochemical processes in the periph- eral and central nervous system (CNS). It is subjective, and the physician must rely on the patient’s perception and description of his or her pain. Alleviation of pain depends on the specific type of pain, nociceptive or neurogenic pain. In many cases, for example, with mild to moderate arthritic pain (nociceptive pain), nonsteroidal anti-inflammatory agents (NSAIDs, see Chapter 42) are effective. Neurogenic pain responds best to anticonvulsants (for example, pregabalin, see p. 188), tricyclic antidepres- sants (for example, amitriptyline, see p. 155), or serotonin/norepineph- rine reuptake inhibitors (for example, duloxetine, see p. 154) rather than NSAIDs or opioids. However, for severe or chronic malignant or nonma- lignant pain, opioids are usually the drugs of choice. Opioids are natu- ral or synthetic compounds that produce morphine-like effects. [Note: The term “opiate” is reserved for drugs, such as morphine and codeine, obtained from the juice of the opium poppy.] All drugs in this category act by binding to specific opioid receptors in the CNS

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