Review of nonopioid multimodal analgesia for surgical and trauma patients

2020 ◽  
Vol 77 (24) ◽  
pp. 2052-2063
Author(s):  
Stephy George ◽  
Meagan Johns
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Multimodal Analgesia ◽  
Transitions Of Care ◽  
Dose Titration ◽  
Patient Specific ◽  
Therapeutic Effects ◽  
Trauma Patients ◽  
Opioid Use ◽  
Nonopioid Analgesics

Abstract Purpose Pain is a frequent finding in surgical and trauma patients, and effective pain control remains a common challenge in the hospital setting. Opioids have traditionally been the foundation of pain management; however, these agents are associated with various adverse effects and risks of dependence and diversion. Summary In response to the rising national opioid epidemic and the various risks associated with opioid use, multimodal pain management through use of nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, α 2 agonists, N-methyl-d-aspartate (NMDA) receptor antagonists, skeletal muscle relaxants, sodium channel blockers, and local anesthetics has gained popularity recently. Multimodal analgesia has synergistic therapeutic effects and can decrease adverse effects by enabling use of lower doses of each agent in the multimodal regimen. This review discusses properties of the various nonopioid analgesics and encourages pharmacists to play an active role in the selection, initiation, and dose-titration of multimodal analgesia. The choice of nonopioid agents should be based on patient comorbidities, hemodynamic stability, and the agents’ respective adverse effect profiles. A multidisciplinary plan for management of pain should be formulated during transitions of care and is an area of opportunity for pharmacists to improve patient care. Conclusion Multimodal analgesia effectively treats pain while decreasing adverse effects. There is mounting evidence to support use of this strategy to decrease opioid use. As medication experts, pharmacists can play a key role in the selection, initiation, and dose-titration of analgesic agents based on patient-specific factors.

Pharmacogenomics in Pain Management: A Review of Relevant Gene-Drug Associations and Clinical Considerations

2021 ◽  
pp. 106002802110038
Author(s):  
Emily Brandl ◽  
Zachery Halford ◽  
Matthew D. Clark ◽  
Chris Herndon
Keyword(s):  
Clinical Practice ◽  
Pain Management ◽  
Health Care Professionals ◽  
Data Extraction ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Opioid Use Disorder ◽  
Patient Specific ◽  
Therapeutic Effects ◽  
Opioid Use

Objective: To provide an overview of clinical recommendations regarding genomic medicine relating to pain management and opioid use disorder. Data Sources: A literature review was conducted using the search terms pain management, pharmacogenomics, pharmacogenetics, pharmacokinetics, pharmacodynamics, and opioids on PubMed (inception to February 1, 2021), CINAHL (2016 through February 1, 2021), and EMBASE (inception through February 1, 2021). Study Selection and Data Extraction: All relevant clinical trials, review articles, package inserts, and guidelines evaluating applicable pharmacogenotypes were considered for inclusion. Data Synthesis: More than 300 Food and Drug Administration–approved medications contain pharmacogenomic information in their labeling. Genetic variability may alter the therapeutic effects of commonly prescribed pain medications. Pharmacogenomic-guided therapy continues to gain traction in clinical practice, but a multitude of barriers to widespread pharmacogenomic implementation exist. Relevance to Patient Care and Clinical Practice: Pain is notoriously difficult to treat given the need to balance safety and efficacy when selecting pharmacotherapy. Pharmacogenomic data can help optimize outcomes for patients with pain. With improved technological advances, more affordable testing, and a better understanding of genomic variants resulting in treatment disparities, pharmacogenomics continues to gain popularity. Unfortunately, despite these and other advancements, pharmacogenomic testing and implementation remain underutilized and misunderstood in clinical care, in part because of a lack of health care professionals trained in assessing and implementing test results. Conclusions: A one-size-fits-all approach to pain management is inadequate and outdated. With increasing genomic data and pharmacogenomic understanding, patient-specific genomic testing offers a comprehensive and personalized treatment alternative worthy of additional research and consideration.

The role of transdermal compounding in opioid safety

2018 ◽  
Vol 14 (1) ◽  
pp. 17
Author(s):  
Caitlin V. Bucher, PharmD ◽  
A.J. Day, PharmD ◽  
Maria Carvalho, PhD
Keyword(s):  
Pain Management ◽  
Healthcare Providers ◽  
Opioid Analgesics ◽  
Opioid Therapy ◽  
Patient Specific ◽  
Therapeutic Effects ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Management Options ◽  
Combination Drug

Since the number of prescriptions for opioid medications have continued to rise, there have been questions about the safety of using opioids in pain management. Traditionally, opioid analgesics were reserved for a few select conditions, such as terminal illness and surgery, but currently opioids have been readily prescribed for multiple conditions. The objective of this manuscript is to clarify the current state of opioid use and to discuss alternative transdermal analgesic therapies in pain management. Transdermal compounded medications are patient-specific and customizable to include different types of drugs, in various dosage strengths, that are to be delivered simultaneously in one application. Due to the different origins and types of pain, treatments may be most beneficial with multiple classes of drugs with various mechanisms of action. In addition, combination drug therapy may include nontraditional pain management options, and has the ability to maximize therapeutic effects of medications through additive or synergistic properties, without increasing the dosage strengths of the drugs. Many of the challenges faced when using oral opioid therapy may be overcome by using transdermal drug delivery since this route of administration reduces adverse effects, increases patient compliance, and limits exposure to potentially abusive drugs. Although prescribing practices surrounding opioids remains to be a controversial topic, the use of compounded pain medications may help healthcare providers effectively treat their patients while avoiding the use of addictive drugs.

Multimodal Analgesia and Opioid Use in Critically Ill Trauma Patients

2019 ◽  
Vol 228 (5) ◽  
pp. 769-775.e1 ◽  
Author(s):  
Kasey L. Hamrick ◽  
Carl A. Beyer ◽  
Jin A. Lee ◽  
Christine S. Cocanour ◽  
Jeremiah J. Duby
Keyword(s):  
Critically Ill ◽  
Multimodal Analgesia ◽  
Trauma Patients ◽  
Opioid Use

Multimodal Analgesia and Decreased Opioid Use in Adult Trauma Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 950-954
Author(s):  
Andrew L. Drahos ◽  
Anthony M. Scott ◽  
Tracy J. Johns ◽  
Dennis W. Ashley
Keyword(s):  
Acute Kidney Injury ◽  
Management Strategies ◽  
Kidney Injury ◽  
Multimodal Analgesia ◽  
The United States ◽  
Control Group ◽  
Trauma Patients ◽  
Opioid Use ◽  
Trauma Service ◽  
The Impact

Background There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. Methods In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. Results A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease ( P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). Discussion Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.

Obstetric Pain

2017 ◽  
Author(s):  
Hans P. Sviggum ◽  
Adam K. Jacob
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Labor And Delivery ◽  
Opioid Use ◽  
Factors Influencing ◽  
Pain Transmission ◽  
Pain Pathways ◽  
Peripartum Period

This chapter on obstetric pain reviews the complex pathophysiologic processes of pain transmission and perception experienced by women throughout pregnancy, management of pain in the peripartum period, and how preexisting chronic pain or opioid use affects the care of parturients. It discusses mechanisms of pain; common pain pathways; and factors influencing the perception of pain during pregnancy, labor, and delivery. It compares the benefits and adverse effects of current strategies for managing maternal pain during labor and after delivery. Finally, it reviews maternal and fetal effects of peripartum pain management in opiate- and non-opiate-dependent mothers.

Perioperative Nonopioid Analgesics of Use in Pain Management for Spine Surgery

2018 ◽  
Author(s):  
Kenneth Fomberstein ◽  
Michael Rubin ◽  
Dipan Patel ◽  
Ivona Truszkowska ◽  
S. Gabriel Farkas
Keyword(s):  
Spine Surgery ◽  
Recovery Process ◽  
Multimodal Analgesia ◽  
Nmda Receptor Antagonists ◽  
Opioid Use ◽  
Adverse Side Effects ◽  
Specific Medication ◽  
Nonopioid Analgesics ◽  
Cox 2

This chapter examines the developing role of multimodal analgesia in reducing opioid requirements/dependency in the postoperative period while also facilitating the recovery process without the unwanted adverse side effects associated with opioid use. It reviews a number of medications used in a multimodal regimen including NMDA receptor antagonists, α‎2 agonists, dexamethasone, gabapentinoids, acetaminophen, NSAIDs, COX-2 selective inhibitors, caffeine, and lidocaine. This chapter also discusses the evidence and implications for the use of a specific medication and in which perioperative setting its use has been corroborated. This chapter includes relevant tables and is written for qualified specialist attendings, fellows, residents, and nurses as well as all practitioners involved in the treatment of pain following spine surgery.

Optimizing Pain Control and Minimizing Opioid Use in Trauma Patients

2021 ◽  
Vol 32 (1) ◽  
pp. 89-104
Author(s):  
Shanna Fortune ◽  
Jennifer Frawley
Keyword(s):  
Virtual Reality ◽  
Pain Control ◽  
Complementary Therapies ◽  
Treatment Effectiveness ◽  
Trauma Patients ◽  
Mirror Therapy ◽  
Opioid Use ◽  
Trauma Population ◽  
Nonopioid Analgesics ◽  
Inflammatory Drugs

Adverse effects of opioids and the ongoing crisis of opioid abuse have prompted providers to reduce prescribing opioids and increase use of multiple nonpharmacologic therapies, nonopioid analgesics, and co-analgesics for pain management in trauma patients. Nonopioid agents, including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, central α2 agonists, and lidocaine, can be used as adjuncts or alternatives to opioids in the trauma population. Complementary therapies such as acupuncture, virtual reality, and mirror therapy are modalities that also may be helpful in reducing pain. Performing pain assessments is fundamental to identify pain and evaluate treatment effectiveness in the critically ill trauma patient. The efficacy, safety, and availability of opioid-sparing therapies and multimodal pain regimens are reviewed.

Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques

JAMA Surgery ◽  
2017 ◽  
Vol 152 (7) ◽  
pp. 691 ◽  
Author(s):  
Elizabeth C. Wick ◽  
Michael C. Grant ◽  
Christopher L. Wu
Keyword(s):  
Pain Management ◽  
Multimodal Analgesia ◽  
Nonopioid Analgesics
Sign in / Sign up

Export Citation Format

Share Document