Pharmacology and Therapeutics of Pain Medications: Part 1

By Pham, Trinh | Drug Topics, May 2013 | Go to article overview

Pharmacology and Therapeutics of Pain Medications: Part 1


Pham, Trinh, Drug Topics


Abstract

Pharmacologic treatment options for pain management can be broadly categorized as non-opioid and opioid analgesics. This second article in our pain management series focuses on non-opioid analgesics, which include acetaminophen, selective and non-selective nonsteroidal anti-inflammatory analgesics, and adjuvant analgesics. These agents are very effective in the management of a variety of acute and chronic pain conditions but are associated with a myriad of side effects. A comprehensive review of the mechanism action of these agents, side-effeds profile, and recommendations for the prevention and management of these effects will be presented. The general principles of analgesic therapy will also be reviewed to guide pharmacists in the process of evaluating the appropriateness of a pain medication regimen and determining alternative analgesic options that will provide optimal pain relief for patients.

Pain is ubiquitous. It affects everyone at some point in their lifetime and all populations are at risk, regardless of age, gender, ethnicity, income, or geographic location. In the U.S., approximately 100 million Americans suffer from chronic pain conditions, more than the number affected with diabetes, coronary heart disease, and cancer combined.1,2 Worldwide, the prevalence rate of chronic pain is 20% and for those age 65 years and older, the prevalence increases to 50%. 3 The four most common types of acute pain people experience, as indicated by The National Institutes of Health Statistics survey, are low back pain (29%), severe headache or migraine pain (17%), neck pain (15%), and facial ache or pain (5%).2 Some other examples of common acute pain in which patients require analgesia include perioperative pain, posttraumatic pain, obstetric pain, and procedural pain. Among many types of chronic pain, those with a high prevalence rate include arthritis (rheumatoid and osteoarthritis), low back pain, headaches, and neuropathic pain.4 As discussed in the first article of this continuing education series in the April issue of Drug Topics, "Pain management for pharmacists: Concepts and definitions," pain significantly decreases quality of life, increases healthcare costs, and results in lost productivity in the workforce.5 On the other hand, when pain is treated appropriately and effectively, patients experience positive outcomes such as improvement in fatigue, sleep, and depression. Furthermore, patients are able to work effectively, have improved quality of life, and may possibly have a reduction in mortality risk.3 Successful management of pain relies on the accurate diagnosis of the pain pathophysiology and the underlying mechanisms of pain because this influences the choice of analgesic. Once the correct assessment and diagnosis of pain has been made, pharmacists have the opportunity to be an integral member of the healthcare team in its management through their knowledge of analgesic drug pharmacology and making recommendations for analgesic therapeutic options based on the pain diagnosis and a patient's comorbid conditions. Furthermore, pharmacists have the capability to assess the risks and benefits of specific analgesic agents based on their side-effects profile, potential drugdrug interactions, and drug-disease interactions. In addition, pharmacists can provide services such as monitoring patients for response to therapy and/or side effects.

Principles of pain management

Pain is considered to be the "fifth vital sign." All individuals should be routinely asked about pain at each outpatient visit, during every shift for hospitalized patients, and more frequently for patients with active and unrelieved pain. The purpose of asking about or screening for pain is to address pain as part of "routine care" for all patients. Once it is recognized that a person is experiencing pain from the screening process, the next step is to assess the pain based on a patient interview, a comprehensive evaluation of the pain that includes performing a medical history, physical exam, and diagnostic studies, as indicated, to arrive at a diagnosis for the patient. …

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