-
Current Pain and Headache Reports Aug 2023A multimodal analgesic approach improves postoperative pain relief and reduces opioid use; however, it is not universally implemented. This review presents the evidence... (Review)
Review
PURPOSE OF REVIEW
A multimodal analgesic approach improves postoperative pain relief and reduces opioid use; however, it is not universally implemented. This review presents the evidence assessing multimodal analgesic regimens and recommends optimal analgesic combinations.
RECENT FINDINGS
The evidence for best combinations of individual patients undergoing specific procedures is lacking. Nevertheless, an optimal multimodal regimen may be determined based on identifying efficacious, safe, and inexpensive analgesics interventions. Key components of an optimal multimodal analgesic regimen include the preoperative identification of patients at high risk for postoperative pain in addition to patient and caregiver education. Unless contraindicated, all patients should receive a combination of acetaminophen, non-steroidal anti-inflammatory drug or cycoxygenase-2-specific inhibitor, dexamethasone, and procedure-specific regional analgesic technique and/or surgical site local anesthetic infiltration. Opioids should be administered as rescue adjuncts. Non-pharmacological interventions are important components of an optimal multimodal analgesic technique. It is imperative to integrate multimodal analgesia regimens within a multidisciplinary enhanced recovery pathway.
Topics: Humans; Pain Management; Analgesia; Analgesics; Acetaminophen; Analgesics, Opioid; Pain, Postoperative
PubMed: 37405552
DOI: 10.1007/s11916-023-01137-y -
Molecules (Basel, Switzerland) Mar 2018The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain,... (Review)
Review
The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients' age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non-steroidal anti-inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti-inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.
Topics: Administration, Cutaneous; Administration, Topical; Analgesics; Analgesics, Opioid; Animals; Humans; Pain
PubMed: 29562618
DOI: 10.3390/molecules23030681 -
Pain Practice : the Official Journal of... Sep 2014Acetaminophen (paracetamol) is a widely used nonopioid, non-NSAID analgesic that is effective against a variety of pain types, but the consequences of overdose can be... (Review)
Review
Acetaminophen (paracetamol) is a widely used nonopioid, non-NSAID analgesic that is effective against a variety of pain types, but the consequences of overdose can be severe. Because acetaminophen is so widely available as a single agent and is increasingly being formulated in fixed-ratio combination analgesic products for the potential additive or synergistic analgesic effect and/or reduced adverse effects, accidental cumulative overdose is an emergent concern. This has rekindled interest in the sites, processes, and pharmacokinetics of acetaminophen oral absorption and the clinical factors that can influence these. The absorption of oral acetaminophen occurs primarily along the small intestine by passive diffusion. Therefore, the rate-limiting step is the rate of gastric emptying into the intestines. Several clinical factors can affect absorption per se or the rate of gastric emptying, such as diet, concomitant medication, surgery, pregnancy, and others. Although acetaminophen does not have the abuse potential of opioids or the gastrointestinal bleeding or organ adverse effects of NSAIDs, excess amounts can produce serious hepatic injury. Thus, an understanding of the sites and features of acetaminophen absorption--and how they might be influenced by factors encountered in clinical practice--is important for pain management using this agent. It can also provide insight for design of formulations that would be less susceptible to clinical variables.
Topics: Acetaminophen; Administration, Oral; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Drug Overdose; Gastrointestinal Absorption; Humans
PubMed: 26013309
DOI: 10.1111/papr.12130 -
Annual Review of Pharmacology and... Jan 2023The study of chronic pain continues to generate ever-increasing numbers of publications, but safe and efficacious treatments for chronic pain remain elusive. Recognition... (Review)
Review
The study of chronic pain continues to generate ever-increasing numbers of publications, but safe and efficacious treatments for chronic pain remain elusive. Recognition of sex-specific mechanisms underlying chronic pain has resulted in a surge of studies that include both sexes. A predominant focus has been on identifying sex differences, yet many newly identified cellular mechanisms and alterations in gene expression are conserved between the sexes. Here we review sex differences and similarities in cellular and molecular signals that drive the generation and resolution of neuropathic pain. The mix of differences and similarities reflects degeneracy in peripheral and central signaling processes by which neurons, immune cells, and glia codependently drive pain hypersensitivity. Recent findings identifying critical signaling nodes foreshadow the development of rationally designed, broadly applicable analgesic strategies. However, the paucity of effective, safe pain treatments compels targeted therapies as well to increase therapeutic options that help reduce the global burden of suffering.
Topics: Female; Humans; Male; Chronic Pain; Sex Characteristics; Neuralgia; Analgesics; Neurons
PubMed: 36662582
DOI: 10.1146/annurev-pharmtox-051421-112259 -
Current Medicinal Chemistry 2021Pain is a symptom of ninety percent of human diseases, and pain management is a very important medicinal problem. Various modulators of the pain response have been... (Review)
Review
Pain is a symptom of ninety percent of human diseases, and pain management is a very important medicinal problem. Various modulators of the pain response have been detected, and analgesic effects are obtained by increasing inhibition or decreasing excitation in the nervous system. Various known analgesic drugs are commonly used to relieve the pain; however, this problem is still not fully resolved by currently available treatments. Available analgesic drugs (non-steroidal anti-inflammatory drugs, opioids and analgesic adjuvants) are not too effective and are severely limited by adverse effects, for example, opioid addiction. Therefore, developing effective pain management is a difficult but necessary task. Thus, there is an urgent need for further development of the design and synthesis of new analgesic agents. The aim of this review is to present recent progress in search of new small molecule analgesics. The structures and effects of new perspective analgesic agents (anti-inflammatory agents, opioid analgesics, adjuvant agents for pain management, and natural compounds) are presented and discussed. The review covers the literature published in 2015-2020 years and includes 173 references.
Topics: Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Humans; Pain; Pain Management
PubMed: 34126884
DOI: 10.2174/0929867328666210614122444 -
Dental Clinics of North America Jan 2024During the development of multimodal pain management protocols, practitioners need to consider the potential risks each treatment modality inherently carries in order to... (Review)
Review
During the development of multimodal pain management protocols, practitioners need to consider the potential risks each treatment modality inherently carries in order to prevent or diminish harmful outcomes. As an example, the part dentists played in the early stages of the opioid epidemic in the United States of America should serve as a cautionary account. By understanding the roots of this crisis, as practitioners we are better equipped to implement the novel analgesic agents available today to optimize post-operative pain control while minimizing any risk of addiction and harm to our communities. It is therefore critical that our colleagues understand the variety of accessible options for pain management to assure that our profession is able to seek adequate and sustainable relief for our post-operative patients. This article will go in depth to explain the analgesic tools practitioners can implement for an effective low-risk protocol, including a combination of NSAIDS and acetaminophen approach, using long-acting local anesthetics such as Exparel, pregabalin, gabapentin, ketamine, dexmedetomidine, and corticosteroids, and enhanced recovery after surgery protocols.
Topics: Humans; Pain, Postoperative; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Pain Management; Acetaminophen; Analgesics, Opioid
PubMed: 37951635
DOI: 10.1016/j.cden.2023.07.003 -
The Veterinary Clinics of North... Jan 2023Advances in reptile cognitive research would help to (1) better qualify behavioral responses to pain experiences, (2) monitor welfare impacts, and (3) model analgesic... (Review)
Review
Advances in reptile cognitive research would help to (1) better qualify behavioral responses to pain experiences, (2) monitor welfare impacts, and (3) model analgesic studies with ecologically relevant insight to better qualify interventional responses. The focus of future analgesic studies in reptiles require the continued elucidation of the opiate systems and the given variations across taxa in efficacy in nociceptive tests.
Topics: Animals; Pain; Reptiles; Analgesics
PubMed: 36402486
DOI: 10.1016/j.cvex.2022.09.004 -
Pain Management Nursing : Official... Jun 2023The aim of this review is to describe the effects of analgesics on sleep. (Review)
Review
OBJECTIVES
The aim of this review is to describe the effects of analgesics on sleep.
DATA SOURCES
Systematic search of the databases of PubMed and the Cochrane Library was performed between January and September 2021.
REVIEW/ANALYSIS METHODS
The search included all articles on the topic published during the past 20 years (2000-2020). The search strategy was developed using a controlled vocabulary of known studies meeting the inclusion criteria and focused on the following terms: chronic pain, pain, sleep disturbance, insomnia, analgesic, analgesic medication, antidepressants, antiepileptic drugs, nonsteroidal drugs, opioids, and quality of life. Two reviewers independently considered the studies for inclusion in the review, assessed the risk of bias, and extracted data.
DESIGN
Review and analysis.
RESULTS
A total of 37 studies met the inclusion criteria: 15 analyzed the effects of opioids, 6 those of nonsteroidal anti-inflammatory drugs and acetaminophen, and 16 the effects of adjuvant analgesics.
CONCLUSIONS
Sleep quality may be adversely affected by a variety of medications used in clinical practice, including those used in analgesic indications. The class of analgesics most affecting sleep quality are opioids.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Quality of Life; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain; Analgesics, Opioid
PubMed: 36543666
DOI: 10.1016/j.pmn.2022.11.002 -
Phytomedicine : International Journal... Feb 2023Oxidative stress is an inevitable process that occurs during life activities, and it can participate in the development of inflammation. Although great progress has been... (Review)
Review
BACKGROUND
Oxidative stress is an inevitable process that occurs during life activities, and it can participate in the development of inflammation. Although great progress has been made according to research examining analgesic drugs and therapies, there remains a need to develop new analgesic drugs to fill certain gaps in both the experimental and clinical space.
PURPOSE
This review reports the research and preclinical progress of this class of analgesics by summarizing known nuclear factor E-2-related factor-2 (Nrf2) pathway-modulating substances.
STUDY DESIGN
We searched and reported experiments that intervene in the Nrf2 pathway and its various upstream and downstream molecules for analgesic therapy.
METHODS
The medical literature database (PubMed) was searched for experimental studies examining the reduction of pain in animals through the Nrf2 pathway, the research methods were analyzed, and the pathways were classified and reported according to the pathway of these experimental interventions.
RESULTS
Humans have identified a variety of substances that can fight pain by regulating the expression of Nrf2 and its upstream and downstream pathways.
CONCLUSION
The Nrf2 pathway exerts anti-inflammatory activity by regulating oxidative stress, thereby playing a role in the fight against pain.
Topics: Animals; Humans; NF-E2-Related Factor 2; Analgesics; Oxidative Stress; Inflammation; Pain
PubMed: 36603339
DOI: 10.1016/j.phymed.2022.154598 -
Seminars in Oncology Nursing Jun 2019To provide an overview of the pharmacologic management of cancer pain. (Review)
Review
OBJECTIVE
To provide an overview of the pharmacologic management of cancer pain.
DATA SOURCES
Peer-reviewed articles, textbooks, Internet.
CONCLUSION
Medications are the mainstay of cancer pain management. Evidence exists for multimodal use of opioids, non-opioids, and co-analgesics to optimally manage cancer pain.
IMPLICATIONS FOR NURSING PRACTICE
Oncology nurses are the front line of pharmacologic pain management for patients. Patient education regarding analgesic administration and potential side effects is paramount to optimizing safe and effective pain management.
Topics: Analgesics; Cancer Pain; Humans; Terminal Care
PubMed: 31056379
DOI: 10.1016/j.soncn.2019.04.004