Pharmacology of pain management in general practice

2016 ◽  
Vol 9 (12) ◽  
pp. 742-752
Author(s):  
Christopher Evans ◽  
Alison Hoggarth ◽  
Colm Lanigan
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Side Effects ◽  
Wide Spectrum ◽  
Pharmacological Action ◽  
The Novel ◽  
Drug Dosing ◽  
Pain Pathways ◽  
Analgesic Agents ◽  
First Time

Pain is described as the fifth vital sign, yet its importance is frequently not fully recognised, despite 68 000 000 analgesic prescriptions being dispensed annually. GPs treat pain in the context of a wide spectrum of patient conditions and co-morbidities, recognising potential drug interactions and side-effects. They also factor in the patient’s anxieties, coping strategies, cultural background and previous experiences of pain. It is no wonder that we frequently do not get it right first time. This article discusses the pharmacological action of the major groups of analgesic drugs, considers common pitfalls, and suggests appropriate drug dosing. A titrated multi-modal approach is recommended to target nociceptor pain pathways, and to reduce the side-effects caused by large doses of monotherapy. It discusses the novel use of analgesic agents previously only used for chronic pain. It does not, however, discuss acute-on-chronic pain, drug tolerance, drug addiction or complex pain management.

Pain medicine

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Strategies ◽  
Multidisciplinary Management ◽  
Pain Medicine ◽  
Pain Pathways ◽  
Patient Groups ◽  
Chronic Pain Conditions ◽  
Sites Of Action ◽  
Specific Management

This chapter summarizes the assessment and management of acute and chronic pain for FRCA. Pain pathways and physiological consequences of pain are considered along with sites of action and the pharmacology of common analgesics. Assessment of pain for different patient groups and settings is explained. Pain management strategies, pharmacological, non-interventional and interventional techniques are described, including multidisciplinary management of chronic pain. Specific management of some common chronic pain conditions, such as trigeminal neuralgia, are discussed in more detail.

scholarly journals TLR9 and COVID-19: A Multidisciplinary Theory of a Multifaceted Therapeutic Target

2021 ◽  
Vol 11 ◽  
Author(s):  
Gillina F. G. Bezemer ◽  
Johan Garssen
Keyword(s):  
World War Ii ◽  
Wide Spectrum ◽  
The Novel ◽  
Vaccine Adjuvants ◽  
Drug Candidates ◽  
Vulnerable Patients ◽  
Medical Need ◽  
Thrombotic Complications ◽  
Novel Coronavirus ◽  
First Time

By mapping the clinical pathophysiology of the novel coronavirus disease 2019 (COVID-19) against insights from virology, immunology, genomics, epidemiology and pharmacology, it is here proposed that the pathogen recognition receptor called toll like receptor 9 (TLR9) might have a pivotal role in the pathogenesis of COVID-19. Severe Acute Respiratory Syndrome Coronavirus 2, is causing the greatest global social and economic disruption since world war II. Lack of a vaccine, lack of successful treatment and limitations of the healthcare workforce and resources needed to safeguard patients with severe COVID-19 on the edge of life, demands radical preventive measures. It is urgently needed to identify biomarkers and drug candidates so that vulnerable individuals can be recognized early and severe multi-organ complications can be prevented or dampened. The TLR9 COVID-19 hypothesis describes a mechanism of action that could explain a wide spectrum of manifestations observed in patients with severe COVID-19. The introduced hypothesis proposes biomarkers for identification of vulnerable individuals and positions TLR9 as a promising multifaceted intervention target for prevention and/or treatment of COVID-19. TLR9 agonists might have value as prophylactic vaccine adjuvants and therapeutic immune stimulators at the early onset of disease. Additionally, in this current manuscript it is proposed for the first time that TLR9 could be considered as a target of “inhibition” aimed to dampen hyperinflammation and thrombotic complications in vulnerable patients that are at risk of developing late stages of COVID-19. The readily availability of TLR9 modulating drug candidates that have reached clinical testing for other disorders could favor a fast track development scenario, an important advantage under the current high unmet medical need circumstances regarding COVID-19.

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.

Mexiletine Usage in a Chronic Pain Clinic: Indications, Tolerability, and Side Effects

2018 ◽  
Vol 1 (21;1) ◽  
pp. E573-E579 ◽  
Author(s):  
Adam Romman
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Cohort Study ◽  
Pain Management ◽  
Side Effects ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Diagnosis ◽  
Pain Clinic ◽  
Chronic Pain Management

Background: Background: Intravenous lidocaine has multiple applications in the management of acute and chronic pain. Mexiletine, an oral lidocaine analogue, has been used in a number of chronic pain conditions although its use is not well characterized. Objectives: To report our experience using mexiletine in a chronic pain population, specifically looking at tolerability, side effects, and EKG changes. Study Design: Retrospective, cohort study. Setting: Multiple pain clinic locations in an integrated multispecialty health system. Methods: All patients who had a mexiletine prescription between August 2015 and August 2016 were queried via the electronic medical record. Each chart was examined for demographics, QTc changes on EKG, length of use, and reasons for stoppage. Results:There were 74 total patients identified in the chronic pain management clinics as receiving at least 1 mexiletine prescription over the 1-year time period. Twice as many women as men received mexiletine prescriptions. Neuropathic pain was the most common primary diagnosis (64%) which included diabetic neuropathy, radiculopathy, and others. Fibromyalgia was the next most common primary diagnosis (28%). A QTc change on the EKG showed a mean decrease of 0.1 ms and median increase of 1.5 ms. At 6 months (180 days), approximately 30% of the patients remained on mexiletine therapy, and 28% remained on the therapy at 1 year (360 days). Median duration of use was 60 days and the mean was 288 days. Neurologic and gastrointestinal side effects were the most commons reason for stoppage. All side effects were mild and resolved with stoppage. After side effects, lack of response, or loss of efficacy, were the next most common reasons for stoppage. Limitations: Pain relief and outcomes were not specifically examined due to confounding factors including interventional treatments and multiple treatment modalities. This was a retrospective, cohort study limited to our specific clinic population with a relatively high loss to follow-up rate. Conclusion:Mexiletine is rarely a first line option for chronic pain management and is often used when multiple other modalities have failed. By reporting our experience, we hope other clinicians may have more familiarity with the drug’s use in a chronic pain practice. It appears reasonably tolerable, may not require frequent EKG monitoring, and can be an appropriate adjunct in the chronic pain population. More research is needed regarding efficacy and dose titration for mexiletine in chronic pain. Key Words: Chronic pain, mexiletine, IV lidocaine, pain, neuropathic pain, neuropathy, fibromyalgia, QTc, tolerability

scholarly journals EVALUATION OF ANALGESIC EFFECT OF TAB TRAILOKYA VIJAYA VATI IN POST-OPERATIVE PAIN IN KSHARKARMA PATIENTS: AN OBSERVATIONAL STUDY

2022 ◽  
Vol 12 (6) ◽  
pp. 37-41
Author(s):  
Kamthe Kunal ◽  
Kohli Pooja ◽  
Wankhede Tushar
Keyword(s):  
Pain Management ◽  
Treatment Group ◽  
Side Effects ◽  
Observational Study ◽  
Activity Profile ◽  
Safety And Efficacy ◽  
Observational Trial ◽  
Post Operative Pain ◽  
Analgesic Agents ◽  
And Robotics

Despite the advances in technology and robotics, the basics of surgical management are not changed drastically. The science of life, Ayurveda has extensive knowledge of surgeries, including complicated procedures mentioned in the classical texts. However, with time, the ability of anaesthetics and analgesic agents has been lost. This resulted in the lagging of Ayurvedic Surgical wisdom and the rise of modern analgesics and anaesthetics in the market. These current products have potential side effects, and hence a safer and better alternative to these products can boost Ayurveda Surgery worldwide. Trailokya Vijaya Vati (TVV) is one such Ayurvedic formulation that is explained for its potent analgesic activity. The present study was conducted to evaluate the safety and efficacy of TVV in post-operative pain management in patients undergoing anorectal procedures. The observational trial suggested a reduction in time to sleep (p < 0.05), less incidence of insomnia and undisturbed sleep in the treatment group than the control. The formulation was also well tolerated with no or minimal requirement of rescue analgesics. The efficacy observed in the study suggests the formulation can be explored further on a larger population with a diverse activity profile.

scholarly journals Virtual Reality for Pain Management to Tackle the Opioid Crisis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sudarshan Ramanan ◽  
Ajay Yekkirala
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Side Effects ◽  
Clinical Intervention ◽  
Public Health Issue ◽  
Prescription Opioid ◽  
Main Stream ◽  
Opioid Crisis ◽  
Recent Developments

The opioid crisis is a serious public health issue of epidemic proportions, building over the past decades. Prescription opioid abuse is one of the key sources of this issue. While pain is usually managed using pharmacological approaches, such as opioids, they produce several unwanted side effects – including respiratory depression and addiction – non-pharmacological approaches can be significant with minimal or no side effects. Recent developments in technology, such as Virtual Reality (VR), show considerable promise for main-stream adoption as one of the non-pharmacological interventions. Preventing a patient’s transition from acute to chronic pain is one instance where VR can presumably be effective. However, challenges remain due to the inherent subjectivity and lack of clear baselines in clinical intervention studies. Here, we review recent studies on the application of VR as a treatment for acute and chronic pain management to primarily understand key technical challenges faced by VR. The secondary goal of this work is to identify possible options to tackle some of the key challenges. Design considerations emerge as one critical component in improving patient engagement.

Acute Pain

2019 ◽  
pp. 241-258
Author(s):  
Nantthasorn Zinboonyahgoon ◽  
Kristin Schreiber
Keyword(s):  
Substance Use ◽  
Pain Management ◽  
Side Effects ◽  
Acute Pain ◽  
Multimodal Treatment ◽  
Treatment Plan ◽  
Multimodal Analgesia ◽  
Management Plan ◽  
Pain Pathways ◽  
Pain Care

Chapter 14 covers the essentials of acute pain care in the hospital and procedural setting. The chapter begins with an overview of the negative physiologic impacts of uncontrolled acute pain. Based on a foundational understanding of pain pathways and nociceptive signaling, it is possible to construct an acute pain management plan incorporating nonpharmacologic, systemic, and focal pharmacologic elements for an effective multimodal treatment plan. Acute opioid management, including analgesic equivalence, is discussed in detail. Benefits, precautions, side effects, and toxicities of opioids are addressed. Naloxone administration is described in detail. Obstetric, regional, nerve blockade, and multimodal analgesia are described. Adjustments to therapy for patients with substance use disorder are addressed in detail.

scholarly journals A Novel Peripheral Action of PICK1 Inhibition in Inflammatory Pain

2021 ◽  
Vol 15 ◽  
Author(s):  
Kathrine Louise Jensen ◽  
Gith Noes-Holt ◽  
Andreas Toft Sørensen ◽  
Kenneth Lindegaard Madsen
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Inflammatory Pain ◽  
Pain Treatment ◽  
Memory Performance ◽  
Current Treatment ◽  
Abuse Liability ◽  
Spontaneous Pain ◽  
Pain Pathways ◽  
Pain Sensitization

Chronic pain is a major healthcare problem that impacts one in five adults across the globe. Current treatment is compromised by dose-limiting side effects including drowsiness, apathy, fatigue, loss of ability to function socially and professionally as well as a high abuse liability. Most of these side effects result from broad suppression of excitatory neurotransmission. Chronic pain states are associated with specific changes in the efficacy of synaptic transmission in the pain pathways leading to amplification of non-noxious stimuli and spontaneous pain. Consequently, a reversal of these specific changes may pave the way for the development of efficacious pain treatment with fewer side effects. We have recently described a high-affinity, bivalent peptide TAT-P4-(C5)2, enabling efficient targeting of the neuronal scaffold protein, PICK1, a key protein in mediating chronic pain sensitization. In the present study, we demonstrate that in an inflammatory pain model, the peptide does not only relieve mechanical allodynia by targeting PICK1 involved in central sensitization, but also by peripheral actions in the inflamed paw. Further, we assess the effects of the peptide on novelty-induced locomotor activity, abuse liability, and memory performance without identifying significant side effects.

Miscellaneous Pharmacology

2017 ◽  
Author(s):  
Ramana K. Naidu
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Side Effects ◽  
Diverse Group ◽  
Chronic Pain Management

This chapter discusses the unique and miscellaneous drugs that play a role in chronic pain management. The therapies can be used for analgesia, to address comorbidities associated with chronic pain, and to manage side effects associated with commonly used analgesics. Essentially, this chapter provides a diverse group of pharmacological questions that are important for the armamentarium of the pain physician. Topics range from neuroleptics to antispasticity drugs and sympatholytic drugs. Knowledge of these sometimes rarely used drugs can be highly useful in challenging situations.

scholarly journals Long-Term Safety and Efficacy of Sub-Lingual Ketamine Trouches / Lozenges in Chronic Non-Malignant Pain Management

2020 ◽  
Author(s):  
Ben Nelson Maudlin ◽  
Stephen Bruce Gibson ◽  
Arun Aggarwal
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Side Effects ◽  
Case Series ◽  
Analgesic Agent ◽  
Duration Of Treatment ◽  
Retrospective Case ◽  
Wide Range ◽  
Chronic Pain Conditions

Chronic non-malignant pain is a disabling condition that results in a reduction in function and quality of life when inadequately managed. Sub-lingual ketamine has been shown to be efficacious for use in chronic pain. Despite its use for decades in chronic non-malignant pain, there is no published long-term data on safety, side effects or adverse drug reactions. We present a retrospective review of twenty-nine patients (n=29) from a metropolitan tertiary pain service who have been receiving sub-lingual ketamine trouches / lozenges between the period of 2012-2019. There was a wide range of dosages used from 25-600mg in divided doses. The duration of treatment ranged from 2-89 months. There was no association with either the dosage or duration of treatment and frequency of side effects. There was an overall reduction in the use of opioids, gabapentinoids or benzodiazepines in 59% of patients with 39% having a complete cessation of an analgesic agent. Side effects were reported in 24%, but only 7% discontinued the treatment due to the side effect (drowsiness). There were no reports of renal impairment, cystitis or hepatotoxicity. This retrospective case-series has demonstrated that sub-lingual ketamine is a safe and effective analgesic agent to use in chronic non-malignant pain management. It is indicated in a variety of chronic pain conditions and has an excellent safety profile, with no association between the frequency in side effects and duration of therapy or total daily dosages. The study has also shown that the safe dose may be higher than the previous consensus.

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