NSAID, Morphine and other painkillers

NSAID, Morphine and other painkillers

Pain is an unpleasant subjective sensation, caused due to a potential or real tissue injury. It is very commonly seen in patients who are suffering from intractable and incurable illness like cancer. Though, many painkillers are available in the market right now, most people are unaware about the different categories of these analgesic medicines and in this article you can learn some of the basic facts about painkillers, their side effects and their common uses.

 Non Steroidal Anti-inflammatory Drugs (NSAID)

These are the most commonly used painkillers all over the world. These drugs act by inhibiting an enzyme called as “Cyclo-Oxegenase” which is involved in the production of Prostaglandin, an important mediator in the perception of pain. Some of the common examples of NSAIDs are Ibuprofen, Dicrophenac, Mephenamic Acid and Meloxicam.

One of the major adverse effect of NSAIDs is that they cost renal impairment and should be used cautiously in patients who are already taking treatments for kidney diseases. Gastritis is another major adverse effect of NSAIDs , this is why most of these drugs are prescribed to be taken after having food when they are taken on empty stomach or before food, they produce increased gastric irritability leading to the sensation of heartburn. Paracetamol when used in higher doses, for eg:- 750mg to 1 gram, 3-4 times a day can produce an analgesic effect in addition to the antipyretic effect.

 Weak Opioids

Codeine and Tramadol are common household names these days and most of you might not be aware of the fact that these medicines are  Opioids. Opioids are several times more powerful painkillers when compared to NSAIDs. As their mechanism of  action is also different., These medicines act by binding two Opioid receptors which are naturally found in our body. Different types of receptors are found in different parts of our body and each one of them have different level of pain perception.

Constipation is the most common adverse effect when it comes to Opioid Drugs and its true in the case of weak Opioids as well. Laxatives like Bisacodyl, Liquid Paraffin, Senna are often prescribed along with weak Opioids. Tramadol is used cautiously in patients who have history of seizure disorders as it has been shown to  reduce the seizure threshold in such patients. Tramadol is commonly available as 50mg tablets.


Morphine is a strong Opioid medicine and  is one of the most powerful  analgesic in the world. It is used by millions of patients who are in severe pain with 100% satisfaction. Similar to the weak Opioids, morphine also acts by binding to endogenous Opioid receptors.

Constipation is much more pronounced in case of morphine use and te use of laxatives becomes unavoidable when prescribing morphine. Another dangerous yet controllable adverse effect of using morphine is the fear of  dependency and addiction. Morphine produces a euphoric effect and combined with the relief in pain it makes the patient a craving for the drug. Many instances have been reported where patients have been found to misuse morphine even after their pain got relieved. Many laws have been governed on the use, availability , storage and distribution of morphine. It is not available for purchase over the counter even in India and doctors are required to get a unique registration to prescribe morphine.

It acts for only 4-6 hours in human body and the regular dosage is usually 4th hourly. Another important feature of morphine is that there is no upper limit for the amount of drug that can be taken per day. This is unlike any other painkiller explained earlier. I have personally known patients who have then taking 150mg of morphine every 4th hourly everyday !

If you feel that your pain is not getting controlled with NSAIDs or Weak Opioids, talk to your doctor about the use of morphine. He will be able to refer you to a pain and palliative specialist doctor who can assess and treat your pain more efficiently with or without using morphine.  Morphine is available in 10mg, 20mg and 50mg tablets.


fentanyl patches

Fentanyl is another strong opioid which is thought to be 100 times more powerful than morphine. It is very expensive when compared to morphine and is commonly available in the form of a transdermal patch. The patch can be applied to any part of the body with bare skin and it works for 72 hours continuously. The patch has then need to be replaced with another one. It is commonly used in patients who have difficulty in swallowing all the medicines like morphine and in those patients with poor drugs complaints.

Because of its powerful analgesic and more stimulating property, it has been widely abused especially by teenagers. It is also not available to buy over the counter and the loss on its use is like that of morphine. It is available in 4 dosage forms, 25, 50, 75 and 100 micro grams per hour.

The spectrum of adverse effects in the case of Fentanyl is a broad one and it ranges from nausea, vomiting to respiratory depression and even death.


These are some of the commonly used painkillers in India. Hope you guys like this article. Have you used any one of the above painkillers? Was it effective in controlling your pain? What side effects did you notice? Share your thoughts in the comment section below and share this article in your favorite social medias.

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