Modern pain therapy

Our country is at the forefront of New Zealand in terms of the percentage of residents suffering from pain – this applies to 27 percent of Poles. The pain is considered a disease in itself and should be properly treated. Recently, an innovative formulation using additive synergy has joined the arsenal of agents enabling an effective analgesic therapy.

Is pain therapy a big problem in medicine?

Yes, this is a big problem that continues to grow as societies age. The longer people live, the greater the diseases associated with advanced age, which are accompanied by pain, such as degenerative diseases of the musculoskeletal system, such as joints, the cross and discopathy, are revealed to them. Every other person over 65 years struggles with pain.

With the help of currently available drugs, we are able to help 95 percent of patients, however – according to statistics – in New Zealand, only 49 percent of patients are treated effectively due to pain. In addition, as many as 36 percent of people undergoing painkillers respond negatively to the question whether they remember how life without pain looks like. This means that the patients suffer despite treatment, and therefore the medications they take are inadequate, both in relation to the pathomechanism of the type of pain and its intensity.

How are painkillers that are available without a prescription?

Drugs from the group of non-opioid analgesics, which include NSAIDs (non-steroidal anti-inflammatory drugs) and paracetamol, are a group of preparations most often used in the pharmacotherapy of pain. They inhibit the generation of pain by blocking the synthesis of prostaglandins, i.e. substances that cause this pain. At the same time, they act on the pathways of pain control in supramaster mechanisms in the central nervous system. Both of these analgesic methods intensify the analgesic effect.

What is hyperadditional synergism?

We deal with it in the case of complex preparations, which are a combination of substances from different groups of analgesics, with a different mechanism of analgesic action, for example paracetamol with tramadol or NSAIDs with tramadol (ie a non-opioid drug with an opioid). The therapeutic effect of such a drug is stronger than if we used each of the components separately. The actions of the constituent substances of the drug do not add up, they only increase. In this case, we therefore have a situation where 1 plus 1 is greater than 2.

Is there an ideal painkiller already available?

It does not exist and will not exist, because we have many types of pain of various etiologies, pathomechanisms, nature (acute and chronic) and degrees of severity. The combination of paracetamol and tramadol gives, for example, very good effects in the treatment of pain in which there is no inflammatory component. However, it does not work on inflammatory pains. For these patients, a new drug appeared, which is the first combination of NSAIDs (in this case dexketoprofen) with the opioid (tramadol).

What are the therapeutic benefits of combining NSAIDs with an opioid?

The composition of two active substances: tramadol and dexketoprofen ensures the use of at least three mechanisms of analgesic action in one drug. But considering the mechanisms of dexketoprofen, we may be tempted to presume an even wider mechanism of action of the combined drug.

The pharmacokinetic profiles of the two components complement each other. Thanks to this, a drug with high therapeutic efficacy has been obtained, which is used in the treatment of acute pain with a significant intensity – from moderate to severe. The more effective pain management in the treatment of this preparation makes it possible to lower its dose compared to the doses of each component individually, if they were used as single preparations. This means that at the same time we reduce the risk of unwanted side effects. As you can see, the benefits are many.

What is the innovation of this preparation?

It is the first and only preparation on the New Zealandan market that combines tramadol with dexketoprofen. These substances were combined in a 3: 1 ratio, which ensures optimal analgesic effect with a very good safety profile of the preparation. Pharmacokinetics of each component: dexketoprofen, which works very fast and tramadol, which slowly develops its activity as a result of hepatic metabolism, are compatible, complement each other and provide effective pain treatment. This innovative formulation uses the phenomenon of hyperadditional synergy, which we discussed earlier. An additional benefit of using this medicine is to improve the quality of the doctor’s cooperation with the patient, because the patient accepts only one tablet instead of two, so it is easier to control the dosage.

Does this drug have a different use than the combination of paracetamol and tramadol?

It is used to treat acute pains in which inflammation plays a significant role in the pathogenesis. In such cases, the drug being a combination of paracetamol and tramadol would be ineffective, while the combination of NSAIDs and tramadol has a therapeutic effect. Heals pains after dental procedures (for example, after surgical removal of a tooth), toothache, postoperative pain, or various types of pain in the movement organ, mainly post-traumatic – associated with contusion, sprain, dislocation, fracture. However, it should not be used for headaches, because tramadol is a substance that works in a serotoninergic system, and some headaches have such a base, so it could even exacerbate the ailments.

It should be remembered that this new drug has been registered as a preparation for short-term, symptomatic treatment of moderate to severe acute pain in adults and for the treatment of such pain is recommended. This means that the treatment should not last longer than a few dozen days.

What is the safety of using this medicine?

There is no drug that would not cause side effects. The advantage of combining two components in this preparation is that its small doses give a significant analgesic effect. The patient therefore takes much less medicine than if he were given dequetoprofen and tramadol alone. Therefore, the risk of adverse reactions is small, much smaller than with any of the components of this medicine. However, it must be remembered that tramadol can cause nausea and vomiting. The compound medicine is not indicated in patients with peptic ulcer with episodes of complications (eg ulcer perforation or upper gastrointestinal bleeding) due to the presence of NSAIDs in the medicine. It should also not be taken by pregnant women and during lactation. It should also be remembered that he may interact with antidepressants and other drugs with serotoninergic effects. In the case of such patients, this medicine should not be used as it may result in a serotonin syndrome.

Is it possible to conduct complementary therapy with painkillers used externally, topically during treatment of acute pain, e.g. post-traumatic pain with this medicine?

This is advisable. Evidence based medicine says that the combination of systemic drugs with locally active drugs gives a better analgesic effect. Modern forms of non-steroidal anti-inflammatory drugs in the form of ointment, gel, spray liquids applied externally at the site of the injury show very good analgesic and anti-inflammatory effects. They are a great complement to oral therapy. There is no concern about the overdose of active substances, because the formulations used externally keep the drug at the site of application. It does not penetrate into the circulation and is not added to the systemic drug.