Category:Analgesics - Revision history

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Phase 2 retag: add Pharmaceutical root parent (taxonomy restructure 2026-05-20)

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	[[Category:MedCategory]]		[[Category:MedCategory]]
	[[Category:MedCategoryFull]]		[[Category:MedCategoryFull]]
			[[Category:Pharmaceutical]]

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	The mechanism of paracetamol is, by contrast, still debated. It is a weak inhibitor of COX-1 and COX-2 and its effect appears to be exerted mainly within the central nervous system; several explanations have been proposed, including a once-suggested "COX-3" variant and an action of its metabolite AM404, but no single account is currently established.<ref name="przybyla2021"/>		The mechanism of paracetamol is, by contrast, still debated. It is a weak inhibitor of COX-1 and COX-2 and its effect appears to be exerted mainly within the central nervous system; several explanations have been proposed, including a once-suggested "COX-3" variant and an action of its metabolite AM404, but no single account is currently established.<ref name="przybyla2021"/>

	Opioids bind opioid receptors — especially the µ-opioid receptor — in the nervous system; the relationship between this binding and their analgesic and other effects is addressed in [[:Category:Opioids]]. The skeletal muscle relaxants are a varied group whose mechanisms are not all well established; baclofen, for example, is understood to act at GABA receptors in the spinal cord, but the detail of its action as a muscle relaxant is described in the literature as incompletely understood.<ref name="witenko2014"/> Adjuvant analgesics — including certain antidepressants and anticonvulsants — are used mainly for neuropathic pain.		Opioids bind opioid receptors — especially the µ-opioid receptor — in the nervous system; the relationship between this binding and their analgesic and other effects is addressed in [[:Category:Opioids]]. The skeletal muscle relaxants are a varied group whose mechanisms are not all well established; [[baclofen]], for example, is understood to act at GABA receptors in the spinal cord, but the detail of its action as a muscle relaxant is described in the literature as incompletely understood.<ref name="witenko2014"/> Adjuvant analgesics — including certain antidepressants and anticonvulsants — are used mainly for neuropathic pain.

	== Members ==		== Members ==
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	== Safety ==		== Safety ==
	Reported adverse effects differ markedly between the families, and figures in the literature are population estimates that vary between studies. NSAIDs are associated with gastrointestinal effects including ulceration and bleeding, with effects on kidney function, and with cardiovascular risk that varies by agent and dose. Paracetamol is generally well tolerated at recommended doses but is associated with serious liver injury in overdose. The muscle relaxants are commonly associated with sedation and dizziness; some, such as dantrolene, carry a warning regarding serious liver injury, and others, such as carisoprodol, have a recognized potential for dependence. The opioids carry distinct risks, including respiratory depression and the potential for dependence, and are discussed separately. Individual response and tolerability are reported to vary considerably between people.		Reported adverse effects differ markedly between the families, and figures in the literature are population estimates that vary between studies. NSAIDs are associated with gastrointestinal effects including ulceration and bleeding, with effects on kidney function, and with cardiovascular risk that varies by agent and dose. Paracetamol is generally well tolerated at recommended doses but is associated with serious liver injury in overdose. The muscle relaxants are commonly associated with sedation and dizziness; some, such as dantrolene, carry a warning regarding serious liver injury, and others, such as [[carisoprodol]], have a recognized potential for dependence. The opioids carry distinct risks, including respiratory depression and the potential for dependence, and are discussed separately. Individual response and tolerability are reported to vary considerably between people.

	== References ==		== References ==

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	Opioids bind opioid receptors — especially the µ-opioid receptor — in the nervous system; the relationship between this binding and their analgesic and other effects is addressed in [[:Category:Opioids]]. The skeletal muscle relaxants are a varied group whose mechanisms are not all well established; baclofen, for example, is understood to act at GABA receptors in the spinal cord, but the detail of its action as a muscle relaxant is described in the literature as incompletely understood.<ref name="witenko2014"/> Adjuvant analgesics — including certain antidepressants and anticonvulsants — are used mainly for neuropathic pain.		Opioids bind opioid receptors — especially the µ-opioid receptor — in the nervous system; the relationship between this binding and their analgesic and other effects is addressed in [[:Category:Opioids]]. The skeletal muscle relaxants are a varied group whose mechanisms are not all well established; baclofen, for example, is understood to act at GABA receptors in the spinal cord, but the detail of its action as a muscle relaxant is described in the literature as incompletely understood.<ref name="witenko2014"/> Adjuvant analgesics — including certain antidepressants and anticonvulsants — are used mainly for neuropathic pain.

			== Members ==
			The analgesics include the [[:Category:NSAIDs]] (such as [[aspirin]], [[ibuprofen]], and [[naproxen]]), [[paracetamol]] (acetaminophen), the [[:Category:Opioids]] (such as [[morphine]], [[oxycodone]], and [[fentanyl]]), and the [[:Category:Muscle relaxants]]. Further agents are used for specific pain syndromes — including triptans, ergot derivatives, and gepants for migraine, and certain antidepressants and anticonvulsants as adjuvants for neuropathic pain. The list is not exhaustive.

	== Safety ==		== Safety ==

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	[[Category:MedCategory]]		[[Category:MedCategory]]
			[[Category:MedCategoryFull]]

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-== Opioids ==
+The relief of pain is among the oldest aims of medicine. Willow bark, rich in salicin, was used as a remedy for pain and fever by Sumerian and Egyptian healers more than three thousand years ago, and was later described by Greek and Roman physicians.<ref name="montinari2019">Montinari MR, Minelli S, De Caterina R. The first 3500 years of aspirin history from its roots — a concise summary. ''Vascul Pharmacol.'' 2019;113:1–8. PMID 30391545.</ref> In 1763 the English clergyman Edward Stone reported to the Royal Society on dried willow bark as a treatment for fever — the first such account in a Western medical journal — beginning the chain of investigation that would lead, more than a century later, to [[aspirin]].<ref name="montinari2019"/>
-[[Opium]]
+'''Analgesics''' — medicines used to relieve pain — do not form a single pharmacological class. They are conventionally grouped into several distinct families: the [[non-steroidal anti-inflammatory drugs]], [[paracetamol]] (acetaminophen), the [[opioids]], a group of adjuvant medicines used mainly for neuropathic pain, and the [[muscle relaxants]], which relieve certain kinds of pain indirectly.
-== SxRIs ==
+== Willow bark and the salicylates ==
-[[Duloxetine]]
+The use of pain-relieving plant materials is ancient, but the modern history of the salicylates begins with the investigation of willow bark. Following Edward Stone's 1763 report, salicin was isolated from willow bark in the early nineteenth century, and salicylic acid was derived from it.<ref name="montinari2019"/>

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			== Opioids ==

	[[Opium]]		[[Opium]]

			== SxRIs ==
			[[Duloxetine]]

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Created page with "Opium"

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[[Opium]]

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	The relief of pain is among the oldest aims of medicine. Willow bark, rich in salicin, was used as a remedy for pain and fever by Sumerian and Egyptian healers more than three thousand years ago, and was later described by Greek and Roman physicians.<ref name="montinari2019">Montinari MR, Minelli S, De Caterina R. The first 3500 years of aspirin history from its roots — a concise summary. ''Vascul Pharmacol.'' 2019;113:1–8. PMID 30391545.</ref> In 1763 the English clergyman Edward Stone reported to the Royal Society on dried willow bark as a treatment for fever — the first such account in a Western medical journal — beginning the chain of investigation that would lead, more than a century later, to [[aspirin]].<ref name="montinari2019"/>		The relief of pain is among the oldest aims of medicine. Willow bark, rich in salicin, was used as a remedy for pain and fever by Sumerian and Egyptian healers more than three thousand years ago, and was later described by Greek and Roman physicians.<ref name="montinari2019">Montinari MR, Minelli S, De Caterina R. The first 3500 years of aspirin history from its roots, a concise summary. ''Vascul Pharmacol.'' 2019;113:1–8. PMID 30391545.</ref> In 1763 the English clergyman Edward Stone reported to the Royal Society on dried willow bark as a treatment for fever, the first such account in a Western medical journal, beginning the chain of investigation that would lead, more than a century later, to [[aspirin]].<ref name="montinari2019"/>

	'''Analgesics''' — medicines used to relieve pain — do not form a single pharmacological class. They are conventionally grouped into several distinct families: the [[non-steroidal anti-inflammatory drugs]], [[paracetamol]] (acetaminophen), the [[opioids]], a group of adjuvant medicines used mainly for neuropathic pain, and the [[muscle relaxants]], which relieve certain kinds of pain indirectly.		'''Analgesics''', medicines used to relieve pain, do not form a single pharmacological class. They are conventionally grouped into several distinct families: the [[non-steroidal anti-inflammatory drugs]], [[paracetamol]] (acetaminophen), the [[opioids]], a group of adjuvant medicines used mainly for neuropathic pain, and the [[muscle relaxants]], which relieve certain kinds of pain indirectly.

	== Willow bark and the salicylates ==		== Willow bark and the salicylates ==
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	== Paracetamol ==		== Paracetamol ==
	Paracetamol (also called acetaminophen) was first synthesized by Joseph von Mering in 1893, though it did not come into wide clinical use until the mid-twentieth century.<ref name="przybyla2021">Przybyła GW, Szychowski KA, Gmiński J. Paracetamol — an old drug with new mechanisms of action. ''Clin Exp Pharmacol Physiol.'' 2021;48(1):3–19. PMID 32767405.</ref> It relieves pain and reduces fever but has little anti-inflammatory effect, and for that reason is generally not classed as an NSAID.		Paracetamol (also called acetaminophen) was first synthesized by Joseph von Mering in 1893, though it did not come into wide clinical use until the mid-twentieth century.<ref name="przybyla2021">Przybyła GW, Szychowski KA, Gmiński J. Paracetamol, an old drug with new mechanisms of action. ''Clin Exp Pharmacol Physiol.'' 2021;48(1):3–19. PMID 32767405.</ref> It relieves pain and reduces fever but has little anti-inflammatory effect, and for that reason is generally not classed as an NSAID.

	== The NSAIDs and the discovery of COX ==		== The NSAIDs and the discovery of COX ==
	Through the twentieth century a large family of '''non-steroidal anti-inflammatory drugs''' (NSAIDs) was developed, including [[ibuprofen]], [[naproxen]], and [[diclofenac]], alongside aspirin. A major advance in understanding came in the early 1970s, when John Vane and colleagues reported that aspirin and similar medicines inhibit the cyclooxygenase (COX) enzyme, reducing the synthesis of prostaglandins — signalling molecules involved in pain, fever, and inflammation. This work was later recognized with a Nobel Prize.<ref name="vane1971">Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. ''Nat New Biol.'' 1971;231(25):232–235. PMID 5284360.</ref> Two principal forms of the enzyme, COX-1 and COX-2, were identified in the early 1990s.		Through the twentieth century a large family of '''non-steroidal anti-inflammatory drugs''' (NSAIDs) was developed, including [[ibuprofen]], [[naproxen]], and [[diclofenac]], alongside aspirin. A major advance in understanding came in the early 1970s, when John Vane and colleagues reported that aspirin and similar medicines inhibit the cyclooxygenase (COX) enzyme, reducing the synthesis of prostaglandins, signalling molecules involved in pain, fever, and inflammation. This work was later recognized with a Nobel Prize.<ref name="vane1971">Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. ''Nat New Biol.'' 1971;231(25):232–235. PMID 5284360.</ref> Two principal forms of the enzyme, COX-1 and COX-2, were identified in the early 1990s.

	== Muscle relaxants ==		== Muscle relaxants ==
	The skeletal '''muscle relaxants''' relieve pain indirectly: rather than acting on pain-signalling pathways, they reduce painful muscle spasm or spasticity, and pain relief follows from that. They are conventionally divided into two groups.<ref name="witenko2014">Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. ''P T.'' 2014;39(6):427–435. PMID 25050056.</ref>		The skeletal '''muscle relaxants''' relieve pain indirectly: rather than acting on pain-signalling pathways, they reduce painful muscle spasm or spasticity, and pain relief follows from that. They are conventionally divided into two groups.<ref name="witenko2014">Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. ''P T.'' 2014;39(6):427–435. PMID 25050056.</ref>

	'''Antispasmodics''' — including [[cyclobenzaprine]], [[methocarbamol]], [[carisoprodol]], [[metaxalone]], and [[chlorzoxazone]] — are used mainly for musculoskeletal conditions such as acute low back pain. '''Antispastics''' — including [[baclofen]] and [[dantrolene]] — are used for spasticity arising from neurological conditions such as multiple sclerosis and spinal cord injury. A few agents, such as [[tizanidine]], are used in both roles.<ref name="witenko2014"/>		'''Antispasmodics''', including [[cyclobenzaprine]], [[methocarbamol]], [[carisoprodol]], [[metaxalone]], and [[chlorzoxazone]], are used mainly for musculoskeletal conditions such as acute low back pain. '''Antispastics''', including [[baclofen]] and [[dantrolene]], are used for spasticity arising from neurological conditions such as multiple sclerosis and spinal cord injury. A few agents, such as [[tizanidine]], are used in both roles.<ref name="witenko2014"/>

	Evidence for the antispasmodics in back pain has generally been limited to short-term relief, and systematic reviews have found the evidence for longer-term use insufficient.<ref name="witenko2014"/>		Evidence for the antispasmodics in back pain has generally been limited to short-term relief, and systematic reviews have found the evidence for longer-term use insufficient.<ref name="witenko2014"/>
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	The mechanism of paracetamol is, by contrast, still debated. It is a weak inhibitor of COX-1 and COX-2 and its effect appears to be exerted mainly within the central nervous system; several explanations have been proposed, including a once-suggested "COX-3" variant and an action of its metabolite AM404, but no single account is currently established.<ref name="przybyla2021"/>		The mechanism of paracetamol is, by contrast, still debated. It is a weak inhibitor of COX-1 and COX-2 and its effect appears to be exerted mainly within the central nervous system; several explanations have been proposed, including a once-suggested "COX-3" variant and an action of its metabolite AM404, but no single account is currently established.<ref name="przybyla2021"/>

	Opioids bind opioid receptors — especially the µ-opioid receptor — in the nervous system; the relationship between this binding and their analgesic and other effects is addressed in [[:Category:Opioids]]. The skeletal muscle relaxants are a varied group whose mechanisms are not all well established; [[baclofen]], for example, is understood to act at GABA receptors in the spinal cord, but the detail of its action as a muscle relaxant is described in the literature as incompletely understood.<ref name="witenko2014"/> Adjuvant analgesics — including certain antidepressants and anticonvulsants — are used mainly for neuropathic pain.		Opioids bind opioid receptors, especially the µ-opioid receptor, in the nervous system; the relationship between this binding and their analgesic and other effects is addressed in [[:Category:Opioids]]. The skeletal muscle relaxants are a varied group whose mechanisms are not all well established; [[baclofen]], for example, is understood to act at GABA receptors in the spinal cord, but the detail of its action as a muscle relaxant is described in the literature as incompletely understood.<ref name="witenko2014"/> Adjuvant analgesics, including certain antidepressants and anticonvulsants, are used mainly for neuropathic pain.

	== Members ==		== Members ==
	The analgesics include the [[:Category:NSAIDs]] (such as [[aspirin]], [[ibuprofen]], and [[naproxen]]), [[paracetamol]] (acetaminophen), the [[:Category:Opioids]] (such as [[morphine]], [[oxycodone]], and [[fentanyl]]), and the [[:Category:Muscle relaxants]]. Further agents are used for specific pain syndromes — including triptans, ergot derivatives, and gepants for migraine, and certain antidepressants and anticonvulsants as adjuvants for neuropathic pain. The list is not exhaustive.		The analgesics include the [[:Category:NSAIDs]] (such as [[aspirin]], [[ibuprofen]], and [[naproxen]]), [[paracetamol]] (acetaminophen), the [[:Category:Opioids]] (such as [[morphine]], [[oxycodone]], and [[fentanyl]]), and the [[:Category:Muscle relaxants]]. Further agents are used for specific pain syndromes, including triptans, ergot derivatives, and gepants for migraine, and certain antidepressants and anticonvulsants as adjuvants for neuropathic pain. The list is not exhaustive.

	== Safety ==		== Safety ==