**2.2. Chronic pain**

the term narcotic as first analgesics as they were narcotics, and their derivatives and analogs were chemically based on the morphine molecule [1]. Additionally, analgesics may include nonsteroidal anti‐inflammatory drugs (NSAIDs) and paracetamol (acetamin‐ ophen). Practically, the term may also include others like tricyclic antidepressants and substances such as gabapentin, although they are not commonly classified as analgesics [1]. It should be well differentiated that usually analgesics give symptomatic relief, but have no effect on the body condition, although NSAIDs are beneficial in both reducing

Why god created pain? To the author, the answer to this question explains the term "productive pain" which has been described in literatures as a warning on the occurring of injury in the body. This pain will guide the person to seek treatment, and this pain will also facilitate diagnosis. "Nonproductive" pain by definition serves no purpose either as a warning or diagnostic tool. It is important for us to understand pain pathophysiology for

Pain syndromes may be different, but their sensory pathways are the same. It starts from the affected organ and the message flow to the brain for interpretation. The pharmacological path of analgesics' action is by working at the level of the nerves, they work by either blocking the signal originating from the peripheral nervous system, or can work centrally by distorting the

Practitioners' selection of an appropriate analgesic is first based on the type of pain and severity and then the knowledge of risk and extra benefit and indirectly considering existing risk‐benefit of a particular drug. The decision will also depend on the knowledge on the classes of drugs, and their adverse effect. Text books have divided pain into two classes, acute and chronic. In selecting the analgesic to be used, severity and predicted survival of patient

Acute pain duration is self‐limiting and this includes postoperative pain, pain of injury, and childbirth. This type of pain is foreseen to be short in duration so the treatment using narcotic pain killer is considered to be safe as there will not be long‐term addiction prob‐ lem on using narcotics. Using NSAIDs will also be beneficial as it allows fluctuation of dose but with limiting concern on the risk of ulcers. For both categories of painkillers, their doses may be adjusted based on observation of healing rate, changing doses from high to low doses, and from narcotic analgesics to nonnarcotics as required. In severe pain, it is the rule of thumb that patients should not be subject to the return of pain so painkiller needs to be dosed adequately to ensure that pain is at least tolerable to avoid the occurrence of anxiety, usually after the return of pain [3]. Generally, in pain management, painkiller

pain and inflammation.

12 Pain Relief - From Analgesics to Alternative Therapies

management purpose.

**2.1. Acute pain**

interpretation by the central nervous system.

must also be considered as a selection criteria [2].

**2. Pain**

Chronic pain is defined as pain lasting over 3 months and severe enough to have effect on body function. This condition is more difficult to treat, as the expected side effects of the drug are more difficult to manage because of the long‐term exposure to the drug. There will be addiction potential for those who are on narcotic analgesics which can exacerbate to respiratory depression and constipation. For those using NSAIDs, the risk of gastric ulcers is evident. Drugs with narcotic agonist‐antagonist properties such as buprenorphine, nalbuphine, pentazocine, or the COX‐2 inhibitors, such as celecoxib and rofecoxib, which reduces the common side effect, are still not recommended for long‐term management of severe pain. Usually, practitioners following the guidelines for chronic pain management will recommend a combination of drug therapy to suite the lifestyle and other treatment modalities [2]. Modification of the delivery system of the drug for the purpose of long‐term treatment is also beneficial [4].
