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Aiden asked:


I understand the pharmacology of morphine and fentanyl (structure, binding sites, differences in mu-, delta-, and kappa- opioid occupancy and potency) so I would like the following question to be answered in the *clinical* context (I’m an RN who works in a Neurosurgical ICU with mainly vented patients):

In your clinical experience, which of the two (morphine or fentanyl) have you found to be the better analgesic with the least potent respiratory depressant action?

(Thank you)

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At some point in our lives, we will experience some sort of chronic pain that we positively hate and wish to go away. But as much as we seek pain relief immediately and despise the discomfort, the truth is that pain is useful to our survival as it alerts us to problems within our body. Pain also prevents a person from further injuring themselves and so it can be very useful. But, while useful, we all seek pain relief from time to time because-well, it hurts!

Oral Pain Relief

Now when most people think of pain relief, the first thing that comes to mind is aspirin or some other form of oral medication. In fact, we have been conditioned to believe that “you take something for the pain” and this usually involves a pill of some kind. For severe or chronic pain, opiates are most often prescribed. Morphine and heroine are two common opiates, and you will generally see cancer patients given these pain medicines as pain relief of last resort. Opiates are considered highly addictive and generally reserved for terminally ill patients.

Anti-depressants once were prescribed solely to treat depression and other mental illnesses. However, recent research has concluded that anti-depressants do relieve certain types of physical pain and are often used in pain relief applications to help a patient sleep.

Anti-seizure medications are prescribed to deal with sharp or acute pain caused by malfunctioning or damaged nerves. They most often deaden or numb the nerves themselves so pain signals do not reach the brain.

Less severe forms of oral pain relief generally come in the form of aspirin or ibuprofen. Ibuprofen are specifically designed to reduce inflammation and are therefore recommended for things like muscle aches while aspirin are more useful on headaches and fever reduction.

Pain Relief From Injections

One of the more severe but useful types of pain relief come in the form of injections. Cortisone treatments are common in athletes and involve an injection directly into the muscle or nerve causing the pain. This sort of pain relief is very effective, but it cannot be done on regular intervals due to tissue damage. Therefore, it is only recommended for temporary relief of acute pain.

Dentists also use this form of pain relief when they inject your mouth with Novocain-or, a local anesthetic. These injections will numb your nerves so that they are no longer sending signals to the brain. The inflammation or source of the pain will remain, but your body won’t feel anything until the local wears off.

Nerve Block Pain Relief

This type of pain relief is related to injections but deals with specific nerve blocks within the body. Called a ganglion or plexus, a nerve block will affect a group of nerves relating to a specific organ or part of the body. The doctor provides an injection of a specific nerve blocker in order to temporarily relieve pain to that organ or part of the body. It is different than a local anesthetic in that it has been specifically designed to affect one type of nerve so it is specialized pain relief and tends to be more expensive than standard cortisone shots or Novocain.

Physical Therapy as Pain Relief

Physical therapy is often viewed as a means to rebuild damaged muscles and nerves after a trauma. However, physical therapy is also used as a natural form of pain relief. Whirlpool therapy, deep muscle massage, and ultrasound are all forms of physical therapy used in natural pain relief treatments.

Electrical Stimulation Pain Relief

Known as TENS, Transcutaneous Electrical Nerve Stimulation is an alternative to more traditional pain relief treatments. Without using any needles or medicine, pain is relieved when tiny electrical impulses are applied to the skin. The electrical current then stimulates nerve fibers in other parts of the skin and has the affect of relieving pain. The effects are only short term but TENS has proven itself as a legitimate means of pain relief and is a standard component of many physical therapy programs.

Acupuncture Pain Relief

While not widely recognized by the medical community as a legitimate form of pain relief, this Oriental treatment has been around for centuries and is considered by its adherents as a very effective pain management tool. Acupuncture specialists use lots of thin, small needles on various pressure points of the body. The pressure points in which a practitioner applies the needles will depend on the source of the pain. Although not a proven form of pain relief, acupuncture does remain one natural alternative to more traditional and accepted forms of pain management.

Surgery

In very severe cases and when other forms of pain relief have failed, surgery may be the last best chance to end chronic pain. In most cases, a surgeon will go in and actually severe nerve connections so that pain receptors in the brain no longer receive signals. Again, this is a method of last resort because as we stated earlier-pain can be useful and necessary to our survival. Doctors don’t like completely severing nerve endings as they will no longer be able to alert your body to problems-but when other forms of pain management fail, surgery may be the only viable alternative.

Topical Pain Relief

Finally, there are also topical ointments, creams, and liquids that can be directly applied to an affected area for temporary pain relief. Topical pain relief has the advantage of being quicker to reduce pain than oral medicines without being as invasive as the injections. While topical pain relief is not recommended for relief of chronic pain, it is highly effective with short term alleviation of minor aches and pains.

Pain relief is something we all must concern ourselves with from time to time. There are a wide array of medical and natural pain relief options available to you, and the one you choose will depend on the nature of the pain and your own comfort level with the treatment. For relief of minor, short-term pain, oral medication is most preferred, but topical pain relief options are growing in popularity and should be considered as a viable option in most cases.

For a topical and natural pain relief product, try ReliefMD to help manage and prevent any of your everyday aches and pains.



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Tramadol (Ultram) is prescribed to relieve moderate to moderately severe pain, to treat pain caused by surgery and chronic conditions such as cancer or joint pain. It works by decreasing the body’s sense of pain.

Gelonida is a narcotic analgesic used to treat or prevent moderate to severe pain.

* Most important fact about Tramadol (Ultram)

You should not drive a car, operate machinery, or perform any other potentially hazardous activities until you know how Tramadol Ultram affects you.

It’s important to take Tramadol exactly as prescribed. Do not increase the dosage or length of time you take Ultram without your doctor’s approval.

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Ultram.

Side effects may include:

Agitation, anxiety, bloating and gas, constipation, convulsive movements, diarrhea, dizziness, drowsiness, dry mouth, feeling of elation, hallucinations, headache, indigestion, itching, nausea, nervousness, sweating, tremor, vomiting, weakness.

Avoid Tramadol Ultram if it has ever given you an allergic reaction. Also avoid Tramadol Ultram after taking large doses of sleeping pills such as Halcion, Dalmane, and Restoril; narcotic pain relievers such as Demerol, morphine, Darvon, and Percocet; or psychotherapeutic drugs such as antidepressants and tranquilizers. And do not take Tramadol Ultram after drinking excessive amounts of alcohol.

If you have stomach problems such as an ulcer, make sure your doctor is aware of them. Tramadol Ultram may hide the symptoms, making them difficult to diagnose and treat.

Tramadol Ultram can cause mental and physical addiction. If you’ve ever had a problem with narcotic painkillers such as Percocet, Demerol, or morphine, you should avoid Tramadol Ultram. Withdrawal symptoms may occur if you stop taking Tramadol Ultram abruptly. Such symptoms include anxiety, sweating, insomnia, pain, nausea, tremor, diarrhea, and respiratory problems. A gradual decrease in dosage will help prevent these symptoms.

Do not take more than the recommended dose of Tramadol Ultram, since larger doses have been known to cause seizures, especially if you have epilepsy or are taking medications that also increase the risk of seizures. Among such medications are almost all antidepressant drugs, plus narcotics and major tranquilizers such as Loxitane and Stelazine.

If you have liver or kidney disease, be sure your doctor knows about it. Your dosage may have to be reduced.

Before you have any kind of surgery, make sure the doctor knows you are taking Tramadol Ultram.

If you have any kind of breathing problem, use Tramadol Ultram with caution or take a different kind of painkiller. Tramadol Ultram can impair respiration, especially if taken with alcohol.

If you have experienced a head injury, consult your doctor before taking Tramadol Ultram. The medication’s effects may be stronger and could hide warning signs of serious trouble.

Tramadol Ultram may increase the drowsiness caused by alcohol. Do not drink alcohol while taking Tramadol Ultram.

There have been reports of serious harm to developing babies when Tramadol Ultram was used during pregnancy. If you are pregnant or plan to become pregnant, tell your doctor immediately.

Tramadol Ultram appears in breast milk and may affect a nursing infant. If Tramadol Ultram is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Avoid Tramadol Ultram, too, if you are taking the seizure medication Tegretol.

Symptoms of Ultram overdose include:

Difficult or slowed breathing, drowsiness, coma, seizures, cardiac arrest. Tramadol can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor.

***** Gelonida *****

Gelonida – generic name is parecoxib sodium. It is used to treat or prevent moderate to severe pain.

* Side effects

That may go away during treatment, include drowsiness, dizziness, constipation, or nausea. If they continue or are bothersome, check with your doctor.

Check with your doctor if you experience vomiting, skin rash, itching, slowed or difficult breathing, difficulty urinating, or fainting.

Don’t take this drug if you are also taking Quinidine. Inform your doctor of any other medical conditions, allergies, pregnancy, or breast-feeding.

If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include cold and clammy skin, slowed breathing, slowed heartbeat, drowsiness, dizziness, lightheadedness, deep sleep, and loss of consciousness.

Avoid alcohol while you are using this drug. This drug will add to the effects of alcohol and other depressants.

Don’t drive, don’t operate machinery until you know how you react to this medicine? Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks.

Don’t take this drug if you have had a severe allrgic reaction to Codeine, Hydrocodone, Dihydrocodeine, or Oxycodone (such as Tylox, Tylenol with Codeine, Vicodin).

A severe allergic reaction includes a severe rash, hives, breathing difficulties, or dizziness.



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