USE FOR THE TREATMENT OF

PAIN & INFLAMATION

An unpleasant sensation occurring in varying degrees of severity as a consequences of injury, disease, or emotional disorder.

Suffering or distress. Pain is a feeling or a perception it varies from

person to person and its intensity depends upon individual response to stimuli.

Informal a source of annoyance; A nuisance.

TYPES OF

Acute pain

Chronic pain

Having a rapid onset and following a short but severe course.

Afflicted by a disease exhibiting a rapid onset followed by short, severe course.

Lasting for a long period of time or marked by frequent recurrence, as certain

disease.

Types Of PainInitiators

Chemical

Mechanical

Thermal

Cell Membrane Thermal Mechanical

Chemical

Phospholipids

OtherInfection

Trauma

Lipoxygenase

Mechanical

Cycloxygense

Phospholipase

Arachidonic Acid

Disruptions

Leukotrins Prostaglandins

PROSTGLANDINS Basic Facts

Prostaglandins are unsaturated fatty acids.

PG are of nine types, A,B,C,D,E,F,G,H and I.

PG are formed on demand.

Reaction of living tissue to all forms of injury.

The body’s major defenses against injury and infection in an attempt to localize and heal it.

It may vary in timing and intensity , depending on its cause & the type of tissue.

Agents Causing

Can broadly classify into four major types:

1) Biological

2) Chemical

3) Physical

4) Immunological

Types Of

An inflammation that lasts for a few minutes, several hours or one to two days.

An inflammation that persists for months or years.

Signs Of

1) Pain

2) Heat

3) Redness

4) Swelling

5) Loss of function

TISSUE INJURY

MAST CELL RELEASE HISTAMINE,KININS,SEROTININ & PROSTAGLANDINS

INCREASED PERMEABILITY

EXDUATE PASSES THROUGHCAPILLART WALL TO INJURED AREA

MIGRATION OF LEUKOCYTESINCREASED BLOOD FLOW

SWELLINGHEAT AND REDNESS

• Enzyme that catalyze the synthesis of PGs• Purified in 1976 and cloned in 1988.• A second COX-2 was discovered in 1991.• The two known COX forms are similar in

size and kinetics but vary in theira) Expression

b) Distribution

COX ( Cycloxygenase )

COX-1 ( The Good COX )

• Cox-1 is present in most cells throughout the body and produce PGs which involved in the physiological processes known as “housekeeping function” also called Good COX.

COX-2 “The Bad COX”• Inducible form, found in inflammatory and

immune cells.• At the sight of inflammation, COX-2 is

responsible for the generation of the hyperalgesic (pain causing) and pro-inflammatory PGs.

• COX-2 is also present in the CNS, where it involved in fever and Neuro-transmission of pain.

• The drug concentration that inhibits the activity of the enzyme by 50%.

• The lower the IC-50 the stronger is the drug.

• Cox-1/Cox-2 are determined in ratio.• Ratio more than 1 = Cox1 selective• Ratio less than 1 = Cox2 selective

Concept Of IC-50

• Arthritis.• Rheumatoid Arthritis.• Osteoarthritis.• Ankylosing Spondilitis.

Pain Related Diseases

Arthritis

• Any type of joint pain or inflammation is called arthritis.

• Multiple Etiology.• Treatment options includes NSAID and

selective And specific COX inhibitors.• If untreated will lead to complications.

Rheumatoid Arthritis

• A systemic connective tissue disorder.• Involving multiple joints.• Usually Small joints.• Symmetrical joints.• Morning stiffness.• Positive RA factor.

Osteoarthritis is a disease of joint characterized by cartilage loss with an accompanying periarticular bone response.

Symptoms of

• Joint pain.

• Joint Instability.

• Loss of joint function.

Signs of

• Joint tenderness.• Crepitus in movement.• Limitation of movement.• Joint Instability.• Joint effusion.• Bony swelling.• Wasting of muscles.

Treatment Options of

• Simple Analgesics.

• NSAIDs.

• COX-2 Inhibitors.

• Inflammatory disease of back especially effecting young.

• There is white cells infiltration.

• Erosion of bone at the place of ligament attachment.

Symptoms of

• Episodic sacroiliac pain.• Buttock Pain.• Stiffness in morning.• Low stiffness after exercise.• Para spinal muscle wasting.

Treatment of

• Simple Analgesics.

• NSAIDs.

• COX-2 Inhibitors

DRUGS USED IN PAIN & INFLAMMATION

NON-NARCOTICS ANALGESICS

NARCOTIC ANALGESICS

ROLE OF IN PAIN & INFLAMMATION

This is a group of medicine which are usedfor the treatment of pain and inflamation.These medicines are also used inosteoarthritis, rheumatoid arthritis and otherconditions associated with pain.

CARBOXYLIC ACID ENOLIC ACIDNON ACID COMPOUNDS

SALICYLIC ACID & ESTERS

ACETIC ACID PROPIONIC ACID FENAMIC ACID

PHENYLACETIC ACIDS

CARBOCYCLIC &HETEROCYCLIC

ACETIC ACIDS

PYRAZOLONES OXICAMS

ANY QUESTION ???