The most important analgesics and their side effects

1. Big picture

Analgesics are drugs used to reduce pain. In neurology, they are especially important in:

headache disorders;
migraine attacks;
tension-type headache;
cluster headache;
trigeminal neuralgia;
radicular pain;
neuropathic pain;
musculoskeletal spinal pain;
postherpetic neuralgia;
central pain syndromes.

The key exam sentence:

In neurology, choose analgesics according to pain mechanism: nociceptive pain responds to paracetamol, metamizole and non-steroidal anti-inflammatory drugs; severe acute pain may need opioids; neuropathic pain needs antiepileptics or antidepressants; migraine needs NSAIDs, triptans or ergot derivatives, while opioids should usually be avoided.

The most important exam trap:

Opioids are not routine treatment for migraine attacks because of addiction and medication-overuse headache.

2. Main classes of analgesics

Class	Examples	Main use	Major side effects
Simple analgesics	paracetamol, metamizole	mild/moderate pain, headache, fever	liver toxicity, agranulocytosis
NSAIDs	aspirin, ibuprofen, naproxen, diclofenac, indomethacin	inflammatory pain, migraine, tension headache, musculoskeletal pain	gastric ulcer, bleeding, renal failure
Opioids	morphine, oxycodone, tramadol, codeine, fentanyl	severe acute pain, cancer pain, selected refractory pain	respiratory depression, sedation, constipation, addiction
Migraine-specific analgesics	triptans, ergotamine, dihydroergotamine	acute migraine

NSAID = non-steroidal anti-inflammatory drug.

The most important analgesics and their side effects

1. Big picture

2. Main classes of analgesics

3. First principle: classify the pain before choosing the drug

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