Analgesics: Uses, common brands, and safety info

Everyone has likely experienced some form of pain in their lifetime. Pain is the most common complaint when seeking medical care as it affects more than 100 million people annually in the United States. If you have experienced pain, you probably have taken an analgesic, also known as painkillers. Analgesics are a type of anesthesia or pain management medication that comes in a variety of options. The chart below provides some of the more common analgesics available along with cost and safety information. 

*Available in prescription and over -he-counter formulations

Other analgesics

• Advil (ibuprofen)

• Aleve (naproxen sodium)

• Anacin (aspirin/caffeine)

• Arthriten (acetaminophen/aspirin/caffeine)

• Arthritis Hot (methyl salicylate/menthol topical)

• Aspercreme (trolamine salicylate topical)

• Azo Urinary Pain Relief (phenazopyridine)

• BackAid Max (acetaminophen/pamabrom)

• Bayer Extra Strength Back & Body (aspirin/caffeine)

• BC Arthritis (aspirin/caffeine)

• Bengay Ultra Strength Cream (methyl salicylate/camphor/menthol topical)

• Capzasin-HP (capsaicin topical)

• Cataflam (diclofenac)

• Celebrex (celecoxib)

• Chloraseptic Sore Throat Spray (phenol oropharyngeal)

• (codeine sulfate) 

• Coricidin HBP Cold & Flu (acetaminophen/chlorpheniramine)

• Demerol (meperidine)

• Dilaudid (hydromorphone)

• Diurex Water Pills (magnesium salicylate/caffeine)

• Excedrin (acetaminophen/aspirin/caffeine)

• Gold Bond Pain Relieving Foot Cream (menthol topical)

• Goody’s Headache Relief Shot (acetaminophen/caffeine)

• Halls (menthol oropharyngeal)

• Icy Hot Cream (methyl salicylate/menthol topical)

• Imitrex (sumatriptan)

• Lyrica (pregabalin)

• Midol (acetaminophen/pamabrom)

• Migranal (dihydroergotamine)

• (morphine)

• Motrin PM (

  ibuprofen/diphenhydramine)

• Methadose (methadone)

• Ofirmev (acetaminophen)

• Oxycontin (oxycodone hcl)

• Pamprin Max Pain + Energy (acetaminophen/aspirin/caffeine)

• Pennsaid (diclofenac topical)

• Percogesic

• Prialt (ziconotide)

• Qutenza (capsaicin topical)

• Tylenol (acetaminophen)

• Unisom PM Pain (acetaminophen/diphenhydramine)

Note: Many of the analgesics listed above are available in several formulations, including adult and children’s formulas (Tylenol vs. Children’s Tylenol) as well as combination pain relievers (Advil vs. Advil Dual Action with Acetaminophen).

What are analgesics?

Analgesics are a type of pain medication used to alleviate different severities of pain. They are classified under anesthesia or pain management drugs. Pain medications are usually quite common as they do not cause loss of consciousness. There are several different classifications for analgesics, but the most common types are usually nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (narcotics), nonopioid analgesics, and salicylates. They are usually grouped by the potency of the medication to determine what form should be used.

How do analgesics work?

Analgesics work in many different ways due to the different types of analgesics available. There are also different types of strengths available for various pain levels. Some analgesic forms available include capsules, tablets, injections, creams, and gels.

What are analgesics used for?

There are a large variety of conditions used for the relief of pain with analgesics. Here are some common pain conditions that are treated with analgesics:

• Wound care/ulcer debridement

• Arthritis

• Nerve pain

• Acute pain

• Sprains

• Strains

• Fractures

• Acute trauma

• Inflammatory conditions

• Appendicitis

• Infections

• Gastritis

• Fibromyalgia

• Rheumatoid arthritis

• Osteoarthritis

• Psoriatic arthritis

• Gallbladder pain

• Tendonitis

• Gastrointestinal pain

• Menstrual cramps

• Headaches

• Migraines

• Body aches

• Chronic pain syndromes

• Postoperative pain

• Toothaches

• Multiple sclerosis

• Bursitis

• Gout

Types of analgesics 

Analgesic combinations (includes narcotic analgesic combinations)

Analgesic combinations usually include having at least one analgesic in combination with another medication. Some combinations will have two different analgesics that can provide different ways to address pain. Usually, the combination therapies will include at least one ingredient of an NSAID, opioid, or acetaminophen. Combination treatments with opioids should always be considered last as they have the potential of becoming habit-forming. Because analgesic combinations have different ingredients, they have a vast variety of how they work, their potency, and how they are absorbed and excreted throughout the body.

Examples of analgesic combinations: Excedrin, Percocet, Vicodin

Antimigraine agents

Analgesics used as antimigraine agents treat migraine headaches that include nausea, vomiting, and light sensitivity. Antimigraine medications are further divided into treatment categories that include ergots, triptans, or NSAIDs. These drug agents were some of the first used for the treatment specifically for migraines.

Examples of antimigraine agents: Imitrex, Migranal, Treximet

CGRP inhibitors

Calcitonin gene-related peptide (CGRP) inhibitors are usually pain relievers for the management of migraines. They work by blocking the effect of CGRP, which is a small protein seen in the sensory nerves found in the head and the neck. Monoclonal antibodies, used for migraine prevention, and CGRP receptor antagonists known as gepants, are the only types available at this time. Gepants can be used for both relief and prevention of migraines. Monoclonal antibodies are administered subcutaneously by injection and are known to have few drug interactions. They also rarely cause liver or kidney damage. Gepants on the other hand are metabolized in the liver and have a higher risk for drug interactions and possible liver damage.

Examples of CGRP inhibitors: Aimovig, Vyepti, Nurtec ODT

Cox-2 inhibitors

Cyclooxygenase-2 (COX-2) inhibitors are a type of NSAID that blocks COX-2 enzymes that reduce inflammation and pain. They are usually for the treatment of mild to moderate pain from inflammation. This occurs due to COX-2 enzymes being responsible for releasing prostaglandins that are released after infection or injury. They also regulate inflammation. The benefit of these medications is they cause less gastrointestinal distress as compared to other analgesics. However, they pose a higher risk of developing stroke or heart attacks.

Examples of cox-2 inhibitors: Celebrex, Vioxx, Bextra

Miscellaneous analgesics

Miscellaneous analgesics are unique as they do not fit any particular category of an analgesic. Tylenol and ziconotide are the only medications in this category. The mechanism of action for these two medications is not fully known. However, experts believe Tylenol works by blocking a specific type of cyclooxygenase enzyme located in the brain. Whereas, ziconotide works by blocking voltage-sensitive calcium channels located in the pain receptors in the spinal cord.

Examples of miscellaneous analgesics: Ofirmev, Prialt, Tylenol

Narcotic analgesics

Narcotic analgesics—also known as opioids or opiates—are pain relievers used for moderate to severe pain. This form of pain mediation is most commonly used and unfortunately has the potential for misuse or abuse. Their use can be for both chronic and acute pain conditions. They work by binding to opioid receptors, such as the mu receptor, that controls pain, pleasure, and addictive behaviors. These medications are most effective when taken under the direction of healthcare professionals for short periods of time.

Examples of narcotic analgesics: Codeine, Fentora, Ultram

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that relieve pain and reduce fever and inflammation. They are mostly used for mild to moderate pain conditions such as headaches, arthritic conditions, and sprains or strains in the body. There are several NSAID options available. They work by blocking cyclo-oxygenase enzymes (COX enzymes). COX enzymes produce prostaglandins that have hormone-like effects that control inflammation, blood flow, and the formation of blood clots.

Examples of NSAID analgesics: Motrin, Naproxen, Voltaren

Salicylates

Salicylate is a salt or ester of salicylic acid found naturally in some plants. Aspirin is a derivative of salicylic acid—known as acetylsalicylic acid. Salicylic acid and acetylsalicylic acid can reduce pain, inflammation, and are antipyretics. A major concern with the use of acetylsalicylic acid is gastrointestinal distress. Also, if consumed in large quantities the medication may be toxic.

Examples of salicylates: Alka-Seltzer, Bayer aspirin, Ecotrin

Who can take analgesics?

Most analgesics are relatively safe for men, women, seniors, and children. The analgesics that require the most caution are narcotics as they pose a high risk of abuse if the medication is not used properly. Considerations should always be taken for the overall health of the person that will be receiving the medication. Seniors should be monitored closely with most analgesics (especially with narcotics) due to their risk of respiratory depression and liver failure—particularly when higher doses are required. Weight considerations are also important with dosing pain medications for children as there is always a concern for potential overdose. 

RELATED: Children’s ibuprofen dosage

Are analgesics safe?

FDA recalls

• A-S Medication Solutions issues voluntary nationwide recall of acetaminophen extra-strength tablets

• Tris Pharma issues voluntary nationwide recall of infants’ ibuprofen concentrated oral suspension

• Pfizer, Inc. issues a voluntary nationwide recall of one lot of Children’s Advil

• PharMEDium Services, LLC issues voluntary nationwide recall of 0.5 mg/mL HYDROmorphone HCl

• Tris Pharma, Inc expands its voluntary nationwide retail recall of ibuprofen oral suspension drops

• Premier Pharmacy Labs issues voluntary nationwide recall

• Exela Pharma Sciences

• Hospira issues voluntary worldwide recall for lots of hydromorphone HCl injection

• PharMEDium Services, LLC issues voluntary nationwide recall

• SCA Pharmaceuticals issues voluntary nationwide recall

Restrictions

Patients with the following conditions should avoid certain analgesics:

• Known hypersensitivity to medication

• Advanced kidney disease

• Advanced liver disease

• Are younger than 2 years old

• Pregnant

• During CABG surgery

• History of GI bleeding

• Coagulation disorder

• Are taking anticoagulant medication

• History of glaucoma

• History of myasthenia gravis

• Uncontrolled blood pressure

• Cannot stop alcohol consumption

• Viral infections and are younger than 20 years old

• Past history of opioid addiction

Can you use analgesics while pregnant or breastfeeding?

Most analgesics should be avoided during pregnancy. There is a high risk for fetal harm with most analgesics and an alternative form must be considered if possible. Acetaminophen is the analgesic of choice when pregnant or breastfeeding as there is no known history of fetal harm with short-term use. NSAIDs are also known for their safety while breastfeeding. However, they should be avoided during pregnancy. If these medications are needed, they should be administered and closely monitored by your healthcare professional.

Are analgesics controlled substances?

There are some analgesics classified as a controlled substance as their pharmacology is habit-forming and pose the risk of dependency to the medication. These are usually narcotic/opioid analgesics. Narcotics range from Schedule II-V drugs. They are associated with serious health risks including overdose, potential addiction, and respiratory depression.

Common analgesic side effects

Adverse effects from analgesics range from minor to major concerns. Here are some common reactions to look for when considering these medications:

• Abdominal pain 

• Agitation

• Anxiety

• Blurred vision 

• Constipation 

• Delayed ovulation 

• Diarrhea

• Sweating 

• Double vision 

• Dizziness 

• Drowsiness 

• Dry mucous membranes 

• Indigestion

• Painful urination

• Bruising 

• Erectile dysfunction

• Fluid retention 

• Headache

• Low blood pressure

• Impaired coordination 

• Insomnia

• Loss of appetite

• Nausea 

• Palpitations 

• Pruritus

• Photosensitivity 

• Rash

• Elevated blood pressure

• Tinnitus

• Urinary retention 

• Bleeding 

• Vomiting

• Swelling

Serious side effects

These are some of the less common but more troublesome side effects associated with the use of analgesics:

• Breathing difficulties

• Heart disease

• Lowered white blood count 

• Serious allergic reaction

• Anemia

• Exfoliative dermatitis 

• Gastrointestinal bleeding 

• Gastrointestinal ulcer

• Heat stroke

• Liver toxicity 

• High potassium levels 

• Critically low blood cell levels

• Inflammation of the inner ear

• Heart attack 

• Kidney damage

• Seizures 

• Stevens-Johnson syndrome 

• Stroke 

• Blood clots

• Toxic epidermal necrolysis

• Reye syndrome

• Tremor

• Psychosis

• Hallucinations

How much do analgesics cost?

Analgesics come in many options and modes of action. Due to this, they have a large price range. Generally, generic analgesics are more affordable than brand names. Many analgesics can be purchased over the counter (OTC) for mild to moderate pain conditions. However, stronger preparations are available with a prescription from a healthcare provider. Analgesics can cost less than $20 for prescriptions treating mild to moderate pain or more than $2,000 for severe pain such as from those undergoing cancer treatments. There are several discounts available for analgesics regardless of the potency needed that may be found at SingleCare.