Analgesic adjuvant

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For other uses, see adjuvant.

An analgesic adjuvant is a

analgesia) in some painful diseases. This is often part of multimodal analgesia, where one of the intentions is to minimize the need for opioids.[1][2][3]

Rationale

Multimodal analgesia refers to the use of multiple classes of medications in order to treat pain from different

molecular mechanisms at once. Prolonged use of higher doses of opioids is associated with increased risk of tolerance and opioid use disorder, so there is a growing trend in the use of multimodal analgesia to treat pain.[4][5][6]

Types

Anticonvulsants

Anticonvulsants work through blockade of sodium and calcium ion channels to reduce glutamate (excitatory neurotransmitter) release.[7] Nociceptor hyper-excitability, due to damage to pain-transmitting neurons, results in chronic neuropathic pain. Common anticonvulsants used to treat neuropathic are gabapentinoids (calcium channel blockers) and carbamazapine (sodium channel blocker).[8] There is some evidence that anticonvulsants may also help with inflammatory pain through reduction of nociceptor hyper-excitability originally due to damage to surrounding tissue.[9]

Antidepressants

Antidepressants act (as treatment for both depression and pain) by modulating serotonin and norepinephrine neurotransmitter metabolism. Descending serotonin pathways in the spinal cord are implicated in modulation of pain perception, especially in chronic pain.[11] Common agents used are serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). Duloxetine, venlafaxine, and amitriptyline are all FDA-approved for chronic musculoskeletal pain, peripheral neuropathy, and fibromyalgia).[12][13][14]

Muscle relaxants

Over-excitation of skeletal muscle can result in spasticity (increased muscle tone) and/or muscle spasms (involuntary muscle contractions) which may contribute to pain.[15] There are several different types of muscle relaxants used for pain with different mechanisms of action. Muscle relaxants often have sedating effect that contributes to analgesia and improved relaxation. Experts disagree over whether muscle relaxants are useful for acute musculoskeletal pain.[16]

Alpha-2 adrenergic agonists

Alpha-2 adrenergic agonists such as clonidine are traditionally used to treat hypertension via inhibition of norepinephrine release.[17] Central alpha-2 adrenergic activation in the locus ceruleus and spinal cord induce sedation and pain modulation respectively.[17] Clonidine has been shown to have some efficacy when treating both acute and chronic pain.[18]

Other pharmacologic compounds

Many other classes of pharmacologic compounds have been found to have analgesic potential in certain situations. Several compounds used as adjunctive analgesics include antihistamines (hydroxyzine, promethazine), cannabinoids, NMDA receptor antagonists (ketamine, memantine), scopolamine, and caffeine.[citation needed]

References

  1. S2CID 214683328
    .
  2. PMID 32696016
    .
  3. S2CID 198378073
    .
  4. PMID 21434879
    .
  5. PMID 31142958
    .
  6. PMID 34281910
    .
  7. S2CID 1388805
    .
  8. PMID 27610084
    .
  9. S2CID 49291532
    .
  10. ^ "DailyMed - TEGRETOL- carbamazepine suspension TEGRETOL- carbamazepine tablet TEGRETOL XR- carbamazepine tablet, extended release". dailymed.nlm.nih.gov. Retrieved 2023-11-08.
  11. PMID 30969611
    , retrieved 2023-11-06
  12. ^ "Cymbalta (duloxetine hydrochloride) capsules" (PDF). FDA Highlights of Drug Prescribing Information. 2010.
  13. ^ "EFFEXOR XR® (venlafaxine Extended-Release) Capsules" (PDF). FDA Highlights of Prescribing Information. 2017.
  14. ^ "Amitriptyline Hydrochloride Tablets, USP". www.accessdata.fda.gov. Retrieved 2023-11-08.
  15. ^ a b Fudin, Jeffrey; Mena, Raouf (11 April 2017). "A Review of Skeletal Muscle Relaxants for Pain Management". Practical Pain Management. 16 (5).
  16. PMID 35289585
    .
  17. ^
    PMID 25849473
    .
  18. PMID 24665248
    .

External links

Look up adjuvant in Wiktionary, the free dictionary.
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