3.1.1. Classification of Non-steroidal anti-inflammatory drugs

Currently used non-steroidal anti-inflammatory drugs with their mechanism of actions, indications, therapeutic advantages and disadvantages are listed in the Table 4.

### 3.2. Physical therapy and rehabilitation

A supporting technique is utilized as a part of the treatment of pain. The most well-known strategies for physical treatment are thermotherapy (heat), cryotherapy (cool), laser treatment, electrotherapy, manual methods, restorative concentrates and kinesiotherapy. These techniques, utilized as a part of a fitting way, may enhance life and portability of a few patients.

#### 3.3. Neuromodulation

Neuromodulating treatments are aimed at stimulating the pain systems. Currently, several neuromodulation methods are used: percutaneous nerve electrostimulation (TENS), peripheral nerve stimulation, acupuncture and vibration. Neuromodulation supports pain treatment


Table 3. Pain conditions and Current analgesics for pain management.



Table 4. Classification of currently used Non-steroidal anti-inflammatory drugs along with mechanism and indications.

methods, and by activating the pain inhibitory mechanisms, one can reduce pain and improve the quality of life of patient with chronic pain.

#### 3.4. Psychological therapies

NSAID Mechanism of action Therapeutic

326 Pain Relief - From Analgesics to Alternative Therapies

COX-1 and COX-2

of COX-1 and COX-2

of COX-1 and COX-2

Naproxen Naproxen is

Oxaprozin Long half-life permit

Meloxicam Long half-life permit

Sulindac Long half-life permit

Aspirin Irreversibly inhibit

Indomethacin Reversible inhibitors

Ibuprofen Reversible inhibitors

Piroxicam Inhibits both COX-1

and COX-2, with preferential binding for COX-2

Salicylates

Acetic acids

Propionic acids

Flurbiprofen Ketoprofen

Oxicams

Fenamates Mefenamic acid

Meclofenamic acid

COX-2 inhibitors

Celecoxib More selectively

inhibit COX-2

advantages

of safety

Diflunisal No anti-pyretic effect

Low cost; long history

once or twice daily

Lower toxicity and better acceptance in some patients

considered by some experts as one of the safest NSAID

once daily dosing

Long half-life permit once or twice daily

once or twice daily

Less GI irritation than

dosing

dosing

aspirin

rheumatoid arthritis Fenoprofen

dosing

Therapeutic disadvantages

common

common

less sever

Upper GI disturbances are

Upper GI disturbances are

Same as indomethacin but

Headache, patent ductus arteriosis, tinnitus, dizziness, prolong bleeding time

GI disturbance in 20%

Less GI irritation than

Diarrhoea, inflammation of bowel, haemolytic

Potential for increasing myocardial infarctions

patients

Piroxicam

anaemia

Very potent should be used only after less toxic agents have proven ineffective

Indications

platelet

of hip

Fever, pain, antiinflammatory, antiplatelet, osteoarthritis,

Fever, pain, antiinflammatory and anti-

Anti-pyretic, analgesic, anti-inflammatory

Fever, pain inflammation, RA, ankylosing spondylitis, osteoarthritis

osteoarthritis, rheumatoid arthritis, ankylosing spondylitis

RA, rheumatoid arthritis, acute to moderate pain

Psychological factors have a big influence on the perception of pain, as well as the effectiveness of the treatment. Therefore, all patients with chronic pain should be able to take advantage of professional psychological help, which can affect the emotional aspect of pain. Among the psychological methods that can be effective as a technique supporting the treatment of chronic pain, the most commonly used are cognitive therapy, behavioural therapy, relaxation techniques and hypnotherapy.

#### 3.5. Invasive methods

These procedures of pain management should be executed and administered by experienced specialists in specific cases. Numbers of methods are available, i.e. individual nerves block, intrathecal administration of drugs (e.g. epidural anaesthesia during childbirth) to neurodestructive



Table 5. Some plant sources under study to develop new analgesics.

procedures (neurolysis, thermo lesion,) and neurosurgery. Advance medicine provides many different methods for the management of pain.
