The state-of-the-art pharmacotherapeutic options for the treatment of chronic non-cancer pain. (3rd May 2022)

• Record Type: Journal Article
• Authors: D'Souza, Ryan S.; Langford, Brendan; Wilson, Rachel E.; Her, Yeng F.; Schappell, Justin; Eller, Jennifer S.; Evans, Timothy C.; Hagedorn, Jonathan M.
• Is Part Of: Expert opinion on pharmacotherapy. Volume 23:Number 7(2022)
• Page Start: 775
• Page End: 789
• Publication Date: 2022-05-03
• Subjects: Chronic pain -- medications -- pharmacotherapeutics -- multimodal analgesia -- adverse effects -- opioid; Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1080/14656566.2022.2060741
• Languages: English
• ISSNs: 1465-6566

Abstract

ABSTRACT: Introduction: Pharmacotherapeutic options continue to expand for the treatment of chronic non-cancer pain. There has been an increasing emphasis on multimodal analgesia. This strategy employs use of multiple analgesic medications each with a distinct mechanism of action, which when administered concomitantly may provide profound analgesia. Areas covered: The authors describe evidence from randomized controlled trials and systematic reviews on a variety of established medications including anti-inflammatory agents, opioids, anti-convulsants, anti-depressants, N-methyl-D-aspartate receptor antagonists, sodium channel blockers, cannabinoids, and alpha-2-receptor blockers. Furthermore, they provide developing evidence on more novel pharmacotherapeutics including alpha lipoic acid, acetyl-L-carnitine, low-dose naltrexone, calcitonin gene-related peptide antagonists, targeted toxin therapy, Nav1.7 inhibitors, neurotensin agonists, purinoceptor antagonists, and sigma-1 receptor antagonists. Furthermore, the authors review the safety and adverse effect profile for these agents. Expert opinion: In this era of the opioid epidemic, clinicians should first offer non-opioid analgesics and employ a multimodal analgesic strategy. Current guidelines recommend a personalized approach to the chronic pain treatment, in each case accounting for type, location, severity, and chronicity of pain. Clinicians should also carefully consider the risk-to-benefit ratio to the patient based on the drug side effect profile, patient age, and comorbidities.