Narcotics are a class of strong pain relieving medicines that are used for the treatment of moderate to severe pain. However, these powerful pain relievers also carry some serious risks if not taken as prescribed.

Opioid Pain Relievers
Opioids, also known as opiates or narcotic analgesics, are the most potent class of pain relieving medicines derived from the opium poppy plant. Some commonly used opioid pain relievers include morphine, codeine, oxycodone, hydrocodone, fentanyl and hydromorphone.

Opioids work by binding to opioid receptors in the brain, spinal cord and other body tissues. This binding interaction reduces the perception of pain and causes sedation. Morphine is considered the gold standard opioid as it is one of the most potent natural analgesics. It works broadly at different opioid receptors and is widely used for moderate to severe acute and chronic pain conditions.

Clinical Uses of Opioids
Opioids are effectively used for management of acute pain conditions like postoperative pain, trauma injury pain and burns pain. They are also prescribed for relieving chronic cancer pain caused due to tumor growth pressing on bones and other tissues. Other chronic non-cancer conditions where opioids provide relief include back pain, osteoarthritis pain and neuropathic pain.

While opioids are excellent Narcotic Analgesics, their usage requires caution due to risk of tolerance, dependence and addiction with long term use. Therefore, opioids are generally reserved for management of moderate to severe pain that does not respond adequately to other pain relievers like NSAIDs (non-steroidal anti-inflammatory drugs).

Common Opioid Side Effects
While opioids effectively relieve pain, their usage is accompanied with some troublesome side effects like nausea, vomiting, drowsiness, constipation and respiratory depression in high doses.

Tolerance and Physical Dependence
Frequent and long-term use of opioids leads to development of tolerance which means higher doses are required over time to achieve the same pain relief. More worrisome is the risk of physical dependence and addiction potential with chronic opioid therapy (COT). This occurs when body adapts to the presence of the drug resulting in withdrawal symptoms like agitation, insomnia, abdominal cramps, diarrhea, vomiting, etc. on abrupt discontinuation of the drug. Therefore, opioids should generally be avoided for treatment of chronic non-cancer pain.

Non-Opioid Analgesics

For mild to moderate pain that does not require strong opioids, non-opioid analgesics offer reasonable pain relief with relatively lesser side effects.

Acetaminophen (Paracetamol)
Acetaminophen or paracetamol is considered a mild analgesic effective for treatment of headaches, toothaches, backaches and fever. It works through indirect inhibition of prostaglandin synthesis in the central nervous system. The maximum daily dose should not exceed 4000 mg and it is generally safe for occasional use. However, overdose can potentially cause liver toxicity.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs like ibuprofen, naproxen and aspirin are non-opioid analgesics with additional anti-inflammatory properties. They work by inhibiting the enzyme cyclooxygenase (COX) involved in prostaglandin synthesis. NSAIDs are widely used for arthritis pain, muscle and joint pain, menstrual cramps, back pain etc. Common side effects include dyspepsia, ulcers, kidney issues, heart problems and allergy in sensitive individuals. Topical NSAIDs offer localized pain relief to joints and muscles with relatively less systemic absorption and side effects.

Tramadol
Tramadol is a synthetic analgesic drug that combines low affinity binding to mu opioid receptors along with inhibition of serotonin and norepinephrine reuptake. It provides effective relief for moderate to moderately severe pain and is generally considered safer than pure opioids with relatively mild side effects. Common side effects include nausea, dizziness, constipation and risk of seizures in overdose.

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