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Pain & Analgesics


Pain is commonly one of the reasons on why patient always seek medical treatment. Although physiologically pain is actually a protective action by the body against injury, pain may also alter patient’s quality of life. Pain has been defined as ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ by the Association of Study of Pain.

Types of Pain

Pain can be categorized as acute and chronic pain. Acute pain is usually resulted by defined causes and injury and lasts between 1 to 3 months whereas pain, which lasts longer than 3 months or exceeds the expected recovery time, is considered as chronic pain.

Pharmacologic Agents (Managing Pain with Over the Counter Medication/ Dispensed Medicine)

Many pain medications are available over-the-counter (without a prescription, or OTC) in the market for short-term relief of joint pain, muscle aches, headache, menstrual cramps and fever. These OTC analgesics are generally well tolerated and safe when used properly. Side effects do occur and in some instances can be serious. There are two major classes of pain relievers available in the market without prescription; they are OTC Pain Reliever such as paracetamol and Non-steroidal Anti-inflammatory Drugs (NSAIDs) which is classified as Group C, which can be sold only as dispensed medicine with entry in Prescription Book.


Paracetamol reduces pain and fever by acting on the brain. Paracetamol is categorized as analgesic and anti-pyeretic but it lacks anti-inflammatory action, in other words paracetamol can act as painkiller and reduce fever at the same time. It is safe if used within the therapeutic indication. It can be said as the safest analgesic in the market since it is well tolerated by adults and pediatrics patient. It is important to take paracetamol not more than the frequency or quantities than those recommended on the label of the bottle or container. Although paracetamol is safe and well tolerated, long term daily dose of more than 4000mg/day may results in liver and kidney damage. Paracetamol is also not recommended in patient who consume moderate to heavy quantities of alcohol.

Non-steroidal Anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that impair the production of prostaglandins in the body. Prostaglandins are natural compounds that are responsible for producing fever, pain, and inflammation. NSAIDs such as Ibuprofen and Naproxen act as anti fever, anti-inflammatory and analgesics (pain killer). All NSAIDs are associated with high risk of stomach & intestines irritation, adverse effects where liver, kidney and hematological system are of concern. Aspirin is one of the common drugs used in reducing inflammation and fever. However the main concern when dispensing patient with aspirin is the gastrointestinal intolerability. Aspirin regularly caused stomach irritation and frequently caused nausea and vomiting. Cautions should be exercised with patient known of nasal polyps, asthma, bleeding disorders and peptic ulcer. Aspirin should be avoided in patients who are taking blood thinning medication such as warfarin since it can increase the risk of bleeding. This also applies to non – aspirin NSAIDs as taking both NSAIDs and warfarin can cause increase in bleeding tendency.

Prescription NSAIDs

Conventional NSAIDs reduces prostaglandin secretion to the stomach and increasing the risk of stomach ulceration. Besides the non prescription NSAIDs, there are selective NSAIDs with lesser effects on stomach. However, these selective NSAIDs should be taken under medical supervision of medical officers. Selective NSAIDs includes COX-2 Inhibitor such as celecoxib and etoricoxib which act through the blockade of Cyclo Oxygenase (COX 2) pathway that contributes to pain sensation.


Pain can be managed through self medication. However if the pain persist more than 10 days then expert opinion should be sought. This is because pain medication needs is usually tailored for the individual in order to effectively manage the pain. If after a course of over the counter pain medication, the pain persists then it is time to visit the doctor Please read and follow the recommended dosage of your medication on the labels and package insert carefully. Should you have any doubt on your medication, please do not hesitate to ask your pharmacist or doctor.


Last reviewed : 20 April 2012
Writer : Siti Nurul Fathihah bt. Baharudin
Reviewer : Che Pun bt. Bujang