Pharmacotherapy of Pain: Clinical Pharmacology of Narcotic and Non- Narcotic Analgesics, Analgesic Potential of Ketorolac and Opioids - Comparative Characteristics

Background: Pain management remains a cornerstone of clinical practice, with pharmacotherapy serving as the primary modality. Analgesics are broadly categorized into narcotic (opioid) and non-narcotic (non-opioid) agents, each possessing distinct mechanisms of action, efficacy profiles, and safety considerations. Objective: This review aims to elucidate the clinical pharmacology of narcotic and non- narcotic analgesics, with a particular focus on the analgesic potential of ketorolac and opioids, and to provide a comparative analysis of their characteristics. Methods: A comprehensive literature review was conducted, encompassing peer-reviewed articles, clinical trials, and pharmacological studies published in PubMed and Scopus- indexed journals. Results: Opioids exert their analgesic effects primarily through mu-opioid receptor agonism, leading to potent pain relief but accompanied by significant adverse effects, including respiratory depression, dependence, and tolerance. Non-narcotic analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, primarily inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis and thereby alleviating pain and inflammation. Ketorolac, a potent NSAID, has demonstrated efficacy comparable to opioids in managing moderate-to-severe pain, with a more favorable side effect profile. Conclusion: While opioids remain the gold standard for severe pain management, their associated risks necessitate cautious use. Non-narcotic analgesics, particularly ketorolac, offer effective alternatives with reduced adverse effects, supporting their role in multimodal analgesia strategies.