Pharmacologic Pain Management

Different Procedures of Pharmacologic Pain Management

Pharmaceutical pain management is one of many treatment options available to relieve pain and improve quality of life. A pain management physician may recommend pain medications or suggest other interventional procedures according to your acute or chronic pain condition. Obtain a full list of available services, treatments, and techniques from Wecare Medical Specialty Group, and determine if interventional pain management is right for you. Some medications may be used together, however, others may not. We will ensure that all medications are administered together in polypharmacy – or the simultaneous administration of multiple medications – according to your pain condition. Sometimes, our physician may employ a multimodal approach, which can involve combining multiple treatments, like NSAIDs and physical therapy, which complement one another and ensure optimal results.

Every medication has risks, whether it is prescribed or available over-the-counter, including potential side effects, drug interactions, addiction, or liver damage. Whenever taking any medication, make sure to inform your physician of any allergies, medications you are taking, and vitamins or supplements you are taking. In addition, our pain management specialists might ask about your medical history and your family’s medical history so that they can identify genetic or predisposing conditions. We will assist you along your journey toward pain relief and improved quality of life if you agree that pharmacologic pain management is right for your acute or chronic pain condition. To treat an acute or chronic condition, what is the most effective approach, and if so, which option is best. Pain management through this method may be just what you need to stop letting pain control your life and start experiencing relief.

Acute vs. Chronic Pain

The pain must be differentiated from chronic pain for the clinician to give the appropriate pharmacological management. Pain that lasts less than six weeks and is associated with a recognizable event such as surgery or trauma has been defined as acute pain. Even without analgesia, acute pain resolves naturally. As defined by the World Health Organization, chronic pain refers to pain that lasts more than six weeks and is caused by persistent pathophysiology. If known, intractable pain has a cause that may never be alleviated. Neuropathological pathophysiology may be behind this, as with neuropathic pain syndromes.

Recent data indicate that appropriate pharmacological management of pain may have a significant impact on pain severity.

Furthermore, mounting evidence confirms that preemptive analgesia (analgesics administered before a painful procedure, for instance, an amputation) and early adequate treatment of acute pain prevent chronic intractable pain from developing.

Adjuvant Pain Medicines

The use of adjuvant analgesics is intended to augment the analgesic effect of opioids, relieve concurrent symptoms that aggravate pain, and/or provide independent narcotic effects for certain kinds of pain. Throughout the analgesic ladder, they can be used. A number of adjuvants, including acetaminophen, NSAIDs, tricyclic antidepressants, and possibly antiepileptic drugs have their own primary analgesic effects and can be used alone or in conjunction.

A special mention should be made in this regard of two cancer pain syndromes. A prostaglandin-mediated component of bone pain may be present in bone metastases. In that case, NSAIDs and/or steroids would be especially valuable in combination with opioids. Any pain that appears severe, increases quickly or is associated with muscle, bladder, or bowel dysfunction should always be treated with cord compression.

Pain caused by neuropathy is seldom controlled by opioids alone. Oftentimes, antiepileptics, steroids, and tricyclic antidepressants are combined with opioids to provide adequate relief. In the following, we have provided a list of common agents with a few remarks about their use.

When inflammatory or peripheral mechanisms are thought to be responsible for the painful stimulus, NSAIDs and/or acetaminophen may be used to adjuvant analgesia with opioids.

Anti-inflammatory properties, mood elevation, antiemetic properties, and appetite stimulation are among the effects of corticosteroids. In addition to their anti-inflammatory properties, they also decrease swelling and pressure on nerve endings by reducing arachidonic acid release to form prostaglandins. The prolonged treatment can be complicated by undesirable effects such as hyperglycemia, weight gain, myopathy, and dysphoria, and psychosis.

Anticonvulsants (such as carbamazepine, valproate, clonazepam, phenytoin, and gabapentin) are used either alone or together with opioids or other neuropathic pain medications to control it. A lot of studies have advocated them for neuropathic pain (including trigeminal neuralgia or nerve root compression) with a shooting or lancinating quality.

Pain management and neuropathic pain management, in particular, can be improved with tricyclic antidepressants (such as amitriptyline, desipramine, imipramine, and nortriptyline). Analgesic properties are innate to these peptides, and they function by modulating nociceptive impulses at a dorsal horn level with enhanced inhibitory modulation. The secondary amine tricyclics (nortriptyline, desipramine) provide effective analgesics and have fewer side effects compared to tertiary amine tricyclics (amitriptyline, imipramine). There is no evidence that selective serotonin reuptake inhibitors are equally useful as tricyclic antidepressants.

As an adjuvant analgesic for bone pain from bone metastases, bisphosphonates (such as pamidronate) and calcitonin are commonly used. Osteoclast-induced bone resorption is responsible for a large portion of bone pain in cancer rather than directly caused by the tumor itself.

It has been reported that both the bisphosphonates and calcitonin inhibit osteoclast activity on bone and that at least some patients report a significant reduction in pain.

Anxiolytics (like lorazepam) and neuroleptics (like haloperidol) are used to treat specific psychiatric disorders that complicate pain management, such as delirium, psychosis, or anxiety disorders. The only drugs that have shown intrinsic pain-killing properties are methotrimeprazine and clonazepam.