The management of pain states: Pharmacologic treatment

Abstract

Pharmacotherapy remains a widely accepted modality for both acute and chronic pain conditions and often represents the patient's first entry into a pain treatment algorithm. Many frequently used or prototypical agents are presented herein and are categorized by their mechanism of action. Common routes of administration, indications, adverse effects, and cautions are reviewed for each agent to provide an appreciation for the diversity of agents available. Both anticonvulsants and select antidepressants have analgesic effects and often serve as the basis for the treatment of chronic neuropathic pain syndromes, whereas nonsteroidal anti-inflammatory drugs are useful for acute and nociceptive pain. Ketamine, ziconotide, and botulinum toxin are presented to demonstrate the diversity of pharmaceutical agents used by pain specialists for refractory chronic pain conditions. Opioids are intentionally presented at the conclusion of the chapter, to provoke the reader to first consider alternative agents when selecting pharmacotherapy for the treatment of pain conditions. By no means of exhaustive discussion, this chapter is designed to present an overview of several commonly used analgesic agents and serves as the foundation for selecting medications to treat pain conditions discussed elsewhere in this monograph.