Painkillers (mixed Analgesics, Opiates & Opioids)

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Painkillers (mixed Analgesics, Opiates & Opioids)
Painkillers (mixed Analgesics, Opiates & Opioids)
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Video: Pharmacology - OPIOIDS (MADE EASY) 2023, February

Painkillers (mixed analgesics, opiates & opioids)

Various substances are used to treat pain. Over-the-counter preparations - so-called peripherally effective or non-opioid analgesics - are mostly used for mild or moderate pain. The focus here is often on getting the body used to the substance (s) it contains, which manifests itself in so-called drug-induced headaches. Painkillers containing opioids (opiates and opioids) sometimes have a strong pain-relieving effect, but also have a high potential for dependence…


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  • Peripherally effective pain relievers
  • Peripherally effective painkillers - diagnosis & therapy
  • Opiates & Opioids
  • Opiates & Opioids - Diagnosis & Therapy
  • Whom can I ask?
  • How are the costs going to be covered?

Peripherally effective pain relievers

Peripheral analgesics are usually used for mild or moderate pain that occurs occasionally. These are often available without a prescription - and contain, for example, active ingredients such as acetylsalicylic acid, paracetamol or ibuprofen. In addition to the analgesic effect, these are also antipyretic and, in some cases, anti-inflammatory.

Painkillers can contain one analgesic substance, but also two or more (so-called combination analgesics, mixed analgesics). The latter contain, for example, non-opioid substances, but possibly also psychotropic substances. Mixed preparations can lead to addiction. Especially in combination with psychotropic substances (e.g. codeine) there is a risk of dependence.

Also, pain preparations containing caffeine, for example, may be taken more frequently due to the stimulating effect of caffeine. In addition, there is a risk of organ damage, especially the kidneys, especially with long-term use of mixed preparations.

If painkillers are taken constantly and incorrectly, persistent headaches can be expected over a long period of time. Long-term use of painkillers can lead to so-called drug-induced headaches.

Pain is a warning signal from the body. Through constant use, these warnings and possible illnesses or injuries can be overlooked or at least the recognition delayed - e.g. migraines, which are interpreted by those affected as a tension headache.

Peripherally effective painkillers - diagnosis & therapy

The headache caused by chronic ingestion is often treated by those affected by further taking (sometimes different) painkillers. Painkillers are also often taken prophylactically, for example out of fear of a headache and in order to be productive.

It is helpful for diagnosis and therapy to keep a pain diary in which the occurrence of the headache, the preparations taken, the number of tablets, etc. are recorded. Essential in the treatment of drug-induced headaches are, among other things, the motivation of those affected, the recognition of the need for a change in behavior and the implementation of this. The doctor provides information about the use of painkillers, their consequences and possible symptoms when stopping the drug.

Mixed analgesics are stopped abruptly during treatment (drug-induced headache). Various other medications can be administered if necessary - e.g. for tension headaches or migraines. Treatment usually takes a few weeks or months and can take place on an outpatient or inpatient basis. Follow-up support can also be useful. If it turns out that an underlying illness is behind the self-treated headache, this is treated.

Opiates & Opioids

Opiates are usually understood as active substances that contain alkaloids of opium or opium. The important ones include morphine and codeine. Both substances are very important in medicine, and they are mainly used as pain relievers. Opioids are semi-synthetic or synthetic substances that have a morphine-like effect. The substances have different degrees of effectiveness, require a prescription and are subject to the Addictive Substances Act (sometimes a drug prescription). Codeine is one of the weakly effective opioids, while morphine and fentanyl are among the highly effective opioids.

Strongly effective opiates or opioid analgesics are important and often essential for the treatment of severe pain (e.g. in cancer, very severe nerve pain). Centrally effective analgesics (which include drugs with opiates or opioids) affect receptors in the CNS and suppress the transmission of pain impulses.

Both opiates and opioids have different analgesic effects, their effect depends on the substance and dose. When used, there is, among other things, a reduced awareness of fear and tension. Feelings such as euphoria and satisfaction as well as lust and ecstasy also occur.

Acute side effects such as nausea and tiredness can occur. Fear, panic, motor excitement and dysphoria are also possible. Other side effects include reduced breathing, vomiting, severe constipation, colic and narrowing of the pupils. Due to the strong effect, life-threatening overdoses can occur relatively easily - in the worst case with fatal outcome, caused by paralysis of the central nervous system and breathing.

Opiates and opioids are very addictive. If drugs containing them are used improperly and without a doctor's prescription and control, a particularly high risk of addiction is to be expected. Those affected try to cover their consumption by falsifying prescriptions and visiting several different doctors.

Opiates & Opioids - Diagnosis & Therapy

Dependence can also occur if a doctor prescribes the treatment of chronic pain. There is an increase in tolerance, which means that the dose of the drug must be increased in order to achieve the same effect and to be able to adequately counter pain - e.g. severe pain in cancer. Dependence in the course of pain therapy is rare. The doctor decides on the need for withdrawal.

If withdrawal is carried out, it is usually carried out on an inpatient basis. Centrally effective analgesics that were used to treat pain can be replaced by other drugs in the course of this. Withdrawal symptoms may appear, such as restlessness, sweating, vomiting, muscle cramps, insomnia, etc.

Among other things, the alkaloids of the opium poppy and the heroin synthetically produced from morphine (diacetylmorphine) are also used / abused as illegal intoxicants. Overdoses mainly affect the area of ​​illegal substance use. For more information on this and on treating addiction to illicit substance use, see Heroin.

Whom can I ask?

The family doctor is a point of contact for those affected by pain. He / she can initiate transfers if necessary. Doctors from various disciplines are involved in the diagnosis and therapy of pain (e.g. for neurology, orthopedics and many more). Further treatment depends on the underlying disease.

Patients with chronic or severe pain due to illnesses can contact the doctors who are already supervising them.

In the case of an addiction, inpatient therapy takes place in specialized addiction clinics or corresponding departments of hospitals. Therapy is mostly interdisciplinary, ie in cooperation with different disciplines.

How are the costs going to be covered?

The costs for the medical examination to clarify an addiction are usually covered by the social security agencies.

The interdisciplinary treatment of addiction disorders (including psychotherapy) also takes place in specialized outpatient and inpatient facilities that have contracts with health insurance providers. For these treatment cases, the costs are generally covered in full. For certain services (e.g. psychotherapy with resident psychotherapists), an application for a cost subsidy can be submitted by the health insurance provider. Further information on cost subsidies, cost coverage, etc. can be found under Services & Costs.

For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website.

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