In search of an ideal analgesic for common acute pain

The choice of an oral analgesic is an important determinant in achieving effective pain relief. Properties of an ‘ideal analgesic’ required for the management of acute pain are discussed and current evidence for the suitability of available analgesics – acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen), opioids and combination therapy – is reviewed. The hypothesis that an ‘ideal analgesic’ for acute pain should have a rapid onset of action, act over an extended period of time, reduce awareness of pain quickly and minimise interruption by pain, be well tolerated and produce analgesia over a wide range of pain types in different patient populations, is proposed herein. Currently available analgesics may fulfil only some of these characteristics and, because individual patient response also varies, the challenge is to define what constitutes an acceptable analgesic for a specific patient or pain type.

Various tools for measurement of each of these characteristics exist, but there is currently no single measure to determine the ‘ideal analgesic’ for a specific patient with a specific pain type that takes into account all the characteristics of an ‘ideal analgesic’ and provides an overall measure to quantify the quality of relief produced.