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Adjunctive Agents in the Management of Chronic Pain
Author(s) -
Guay David R. P.
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.13.1070.34622
Subject(s) - medicine , postherpetic neuralgia , gabapentin , chronic pain , neuropathic pain , pain ladder , pregabalin , adverse effect , carbamazepine , lamotrigine , adjunctive treatment , anesthesia , neuralgia , cancer pain , cancer , epilepsy , physical therapy , alternative medicine , pathology , psychiatry
Chronic pain syndromes include cancer‐related pain, postherpetic neuralgia, painful diabetic neuropathy, and central poststroke pain and are common in the elderly. Adjunctive (or adjuvant) analgesics, defined as drugs that do not contain acetaminophen and those not classified as nonsteroidal antiinflammatory or opioid agents, play a role in the management of chronic pain. The term “adjunctive” (or “adjuvant”) is a misnomer as several of these agents may constitute first‐line therapy for many chronic pain syndromes. Tricyclic antidepressants have formed the backbone of therapy for chronic neuropathic pain for years. However, the difficulty with using agents of this class, due to their clinically significant adverse‐event potential, has led to the evaluation of other agents, most notably, the antiepileptic drugs. The most useful are gabapentin, carbamazepine, and lamotrigine. In selected patients, baclofen, mexiletine, and clonidine may be useful as well. Cancer‐related pain may respond substantially to corticosteroids, and pain associated with bone metastases to parenteral bisphosphonates and strontium. Practitioners should consider these alternative agents when treating chronic pain.