A number of drugs are available that act peripherally, probably by inhibition of prostaglandin synthesis, and these drugs are used extensively for relief of less severe pain, particularly skeletal pain. They are effective by mouth.
Aspirin is the most commonly used, and alternative drugs and mixtures have little advantage over aspirin, but tolerance varies from patient to patient.
Gastric irritation is a problem with aspirin, especially if the patient has a gastric ulcer or alcoholic gastritis.
Renal damage from phenacetin, and the possibility of hepatic damage from paracetamol has been recognised.
Milder analgesics should not be combined with sedatives, it is necessary to use the drugs independently in the optimum dose for each.
For adults the usual dose is:
aspirin - 600 mg
paracetamol - 1 G
(repeated after 4 hours if necessary, up to 24 hours.)
If these doses do not give relief, further investigation of the cause of the pain is necessary.
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