The document discusses painkillers and anti-depressants. It provides an overview of common pain sites and medication types used to treat pain, including nerve blockers, muscle relaxants, NSAIDs, and corticosteroids. The document then lists specific painkillers and anti-depressants, and details potential side effects like dizziness, drowsiness, and risk of addiction from long-term use. It also examines the physiological mechanisms of various painkillers and interactions with food, caffeine, supplements, and alcohol.

1. PAINKILLERS & Anti-depressants
Dt. Jenifer Antony M. Sc., PGDFN
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2. General points
• Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
• The common sites or origin of pain are back, eye, head, teeth, stomach, bone, tongue etc.
• The triggered pain can be of different types like severe, moderate or even mild.
• Reason behind consuming medication is to improve the quality of life.
• Painkiller use and abuse also can affect nerve cells.
• It is important to realize that every pain killer is associated with some side effects in short term or long term.
• Therefore it is advised to learn and identify potential disadvantages before consuming any painkiller.
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3. Introduction
• The pain which is triggered by any damaged or sensitive nerves (shingles) is usually managed by nerve
blockers or anti-depressants.
• Some painkillers are used as muscle relaxants to decreases the intensity of pain triggered by the muscles
group. This pain killer act as sedative for central nervous system.
• Pain killers which are NSAIDs (non-steroidal anti-inflammatory drugs) works on the patho-physiological
processes that elicit pain, fever and other signs of inflammation in the body.
• Corticosteroids pain killers are usually given for the management of musculoskeletal injuries due to its effect
on shutting down inflammation causing processes.
• These tablets have the capacity to modulate the perception of pain by central nervous system and cause
Central Nervous System Disorders (CNSD) which affect the brain and the spinal cord.
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4. List of Painkillers & anti-depressants
• Paracetamol
• Ibuprofen
• Codeine
• Amitriptyline and Gabapentin
• Morphine
• Acetaminophen (Tylenol)
• Advil and Motrin
• Tremodol
• Hydrocodone
• Oxycodone and Narcotics
• Opiate pain relievers
• Selective serotonin reuptake inhibitor (SSRI) anti-depressants
• Serotonin and norepinephrine reuptake inhibitor (SNRI) anti-depressants
• Tricyclic and tetracyclic anti-depressants
• Corticosteroids
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5. Causes
 Dizziness
 Drowsiness
 Fatigue
 Headache
 Confusion
 Skin rash
 Nausea and vomiting
 Swelling of hands and feet
 Increased appetite
 Increased risk of infection
 Feeling faint
 Loss of appetite.
 Diarrhoea
 Anxiety
 Weight gain.
 Dry mouth
 Decrease in sexual desire or ability.
 Sleep problems.
 Weight loss.
 Blurred vision.
 Constipation
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6. Physiological side effects
• Action directly on intestine and in CNS, it increases tone and segmentation but decreases propulsive movements.
• Tone of duodenum and colon may be increased to the level of spam.
• Spam of pyloric, ileo faecal and anal sphincter.
• Acute left ventricular failure
• Decrease in all gastrointestinal secretion
• Central action causing in attention to defecation reflex.
• Mild hyperglycemia due to Central sympathetic stimulation.
• Painkillers cause chemical changes to the brain and also kills brain cells.
• The most affected areas of the brain are those areas that deal with cognition, learning and memory.
• Painkiller abuse can cause long-term heart damage and increase the likelihood of a heart attack.
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7. Mechanism
• Opiates and their analogs interact at the various opioid receptors in the brain, they have a wide range of side
effects.
• When a painkiller attaches to the opioid receptor, it prevents a chemical known as GABA from being
released.
• This chemical normally controls the release of dopamine, along with a couple of other neurotransmitters,
which causes dopamine to flood the brain, creating the high.
• Narcotic painkillers bind to opiate receptors which are typically bound by special hormones called
neurotransmitters.
• When painkillers are used for a long period of time, the body slows down production of these natural
chemicals and makes the body less effective in relieving pain naturally.
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8. Cont..
• That is because narcotic painkillers fool the body into thinking it has already produced enough chemicals as
there becomes an overabundance of these neurotransmitters in the body.
• Existing neurotransmitters have nothing to bind with, as the drugs have taken their place on the opiate
receptors.
• Because of this occurrence, the levels of naturally occurring neurotransmitters in the body decreases and
the body builds an increased tolerance to the painkillers so more of the substance is needed to produce the
same effect.
• Many of the neurotransmitters that are decreased include natural endorphins that are considered feel-good
chemicals in the brain that also help with pain.
• Therefore, chemical dependency increases and likelihood of addiction increases as the body is unable to
produce the natural chemical needed to relieve pain.
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9. The symptoms of sudden withdrawal of opiate include:
• Chills
• Nausea
• Tremors
• Diarrhoea
• Irritability
• Sweating
• Insomnia
• Weakness
• Uneasiness
• Abdominal cramps
• Runny nose and eyes
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10. Effect on nutritional status
• Nutritional status may also be impacted by a drug's effect on the three main nutrients: carbohydrates, fat
and protein .
• A drug may speed up or slow down the breakdown of these three nutrients, which are essential to the body's
functioning.
• Salicylic acid, the active ingredient in aspirin and other painkillers, is a gastrointestinal irritant, increasing the
permeability of the gut wall.
• This in turn upsets the absorption of nutrients, allowing incompletely digested foods to pass into the
bloodstream, alerting the immune system and triggering allergy responses to common food.
• In the long term, this weakens the immune system, encourages inflammation and burns up vital vitamins and
minerals needed for healthy immunity, as well as triggering intestinal bleeding.
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11. Analgesic
Food: For rapid relief, take on empty stomach.
Caffeine: May increase the rate of absorption of the drug.
Avoid alcohol.
NSAIDs
Food: Take with food, water, or milk to decrease stomach upset. With a high dose of this drug, one may need
to increase consumption of vitamin C, K and folate.
Caffeine: Limit intake.
Supplements: Limit or avoid products that affect blood coagulation (garlic, ginger, gingko, ginseng, or horse
chestnut).
Avoid alcohol.
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12. Corticosteroids
Food: Take with food or milk to decrease stomach upset.
Limit grapefruit and other citrus fruits.
While taking this drug, one may need to decrease sodium and supplement the diet with calcium, vitamin D, K, A, C or
protein.
Caffeine: Limit intake.
Avoid alcohol.
Narcotic drugs
Food: Take with food or milk to decrease stomach upset.
Avoid alcohol.
Antidepressant drugs
Food: These medications can be with or without food.
Avoid alcohol.
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13. Thank you
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