Pharmacologic Approach to Pain Management

 

Pain is a multidimensional problem ranging from discomfort to agony and affecting physical, emotional, and cognitive function as well as interpersonal relationships and social roles. In this section you will learn more about pain, its causes, evaluation and treatment utilizing medications.

 

Medications

 

Effective pain management, particularly for chronic pain, is best achieved using a patient-centered, multidisciplinary, multimodal, integrated approach that may include pharmacotherapy. In general, two broad categories of medications are used for pain management: opioids and a variety of nonopioid classes of medications.

 

Acetaminophen can be effective for mild to moderate pain. Risks of acetaminophen can include dose-dependent liver toxicity, especially when taken at high doses or by those with liver disease. This risk further illustrates why patients should be aware of the presence of acetaminophen in both over-the-counter and prescribed combination medications.

 

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin , ibuprofen , and naproxen can provide significant pain relief for inflammation, such as arthritis, bone fractures or tumors, muscle pains, headache, and acute pain caused by injury or surgery.

 

Anticonvulsants are medications originally developed to treat seizures but are also commonly used to treat different pain syndromes, including postherpetic neuralgia, peripheral neuropathy, and migraine. They are often used as part of a multimodal approach for the treatment of pain in the perioperative period.

 

Antidepressants are commonly used in various chronic pain conditions.

 

Anxiolytics, including benzodiazepines, are often prescribed for anxiety and stress associated with chronic pain. Benzodiazepines do not have independent analgesic effects but can have indirect pain-relieving effects because of other mechanisms of action.

 

 

Opioids are broad-spectrum analgesics that provide pain relief for a wide variety of conditions. Administration of opioid medication can include short- versus long-acting formulations  and different delivery modalities, such as oral, intravenous, per-rectum, transdermal patches and lozenge formulation.