Pain is an uncomfortable feeling that reminds us of the existence of our organs.
Painkillers (NSAID: Non Steroid Anti-Inflammatory Drug) are among the most commonly used drugs for low back and neck pain. Its uses are to relieve inflammation and pain.
Inflammation; It is a normal defense mechanism against tissue damage, chemical, traumatic, infectious…. It is an effort to remove harmful metabolites from the environment. Metabolites and damage formed in this process are transmitted to the central nervous system by free nerve endings in the tissue, some chemical reactions develop and pain occurs as a result. Because NSAIDs prevent the development of these reactions, they prevent inflammation, tissue damage and ultimately pain. The enzyme called cyclooxygenase (COX-1,COX-2) plays a major role in the formation of these metabolites. NSAIDs inhibit (obstruct) the synthesis of this enzyme. While COX-1 is found in the structure of cells, COX-2 is synthesized (formed) as a result of inflammatory stimuli. It also has an antipyretic effect.
The most typical drug of NSAIDs is ASPIRIN (acetylsalicylic acid = salicylate). The NSAID with the shortest half-life is Aspirin.
NSAIDs are several groups according to their chemical structures:
1-Salicylates: Aspirin, diflunisal, Salicylate salts
2-Propionic acid derivatives: Ibuprofen, Naproxen, Phenopropene, Ketoprpfen ,Flurbiprofen
3-Indolacetic acid derivatives: Indomethacin, Sulindac, Etodolac, Ketorolac
4-Phenamats: Mefenamic acid, mekilophenamate
5-Pyrazolazonopyrin, 5-Pyrazolonenopyrin, phenamate
6-Paraaminophen derivatives:Acetaminophen(paracetamol),Fenacetin
7-Others:Diclofenac,Ketorolac,Tolmetin,Nabumetone
Diclofenac,to synovial fluid(fluid in joint cavity) It can accumulate here. It is stronger than indomethacin or naproxen.
Paraaminophens have low effects on the COX enzyme in peripheral tissues, therefore their anti-inflammatory effects are weak. They do not impair the platelet (Coagulation cells) function. In long-term use, it may cause damage to the liver and kidney.
NSAIDs can be administered orally (orally), suppository (rectally), parenterally (intravenously and intramuscularly), topically (in the form of gel, ointment). They are eliminated (excreted from the body). Therefore, in case of a disorder in these systems (low/high protein amount in the blood, kidney and liver diseases..) their effects and side effects may decrease/increase.
Metabolites are also normally found in the cell structure and have functions in the protection of the cell. However, when they are secreted excessively with some effects, they cause inflammation.
They can cause platelet dysfunction by inhibiting the synthesis of thromboxanes. Essentially, this effect is more prominent at low doses of aspirin. Therefore, aspirin is used as an antiaggregant (blood thinner) at low doses.
Prostaglandins are also secreted by stomach cells and protect stomach cells from acid. Because NSAIDs inhibit Prostaglandins, they increase acid locally and damage the stomach. Therefore, they are never used in gastritis, ulcer pain.
Like all drugs, they can cause allergies.
Prostaglandins play an important role in lung functions, they have bronchial dilator effects. Therefore, they should be used with caution in patients with bronchial constriction such as asthma.
It is undesirable to use with alcohol as it may increase liver damage.
In general, NSAIDs are used as a pain reliever in musculoskeletal pain, headache and toothache, as antipyretic in febrile conditions, and as anti-inflammatory. On the other hand, they are not used in those who are allergic to the active substance, gastrointestinal system disorders, bleeding disorders, liver and kidney diseases, or their use should be under the supervision of a physician.
NSAIDs with common gastrointestinal problems: Aspirin, Phenylbutazone, Indomethacin
NSAIDs with frequent effects on the central nervous system: Indomethacin, Phenylbutazone
Low side-effect NSAIDs: Nabuprofen NSAIDs may interact with other drugs being used. Antihypertensive) Drugs that increase the effect: They increase the effect of blood thinners such as Coumadin.
As a result, NSAIDs are drugs that have a wide range of uses and each of them has different characteristics. They are very useful when used in the right patient, in the right way, in the right dose, at the right time. For this reason, it will be very useful to consult a physician before taking a pain reliever for whatever reason.
