Adjuvant Pain Therapy

Question 1

Common neuropathic pain adjuvants

Answer 1

TCAs
SNRIs
Anticonvulsants
Anesthetics

Question 2

TCA drug doses

Answer 2

Desipramine 10-150 mg PO QHS
Amitriptyline 10-150 mg PO QHS
Imipramine 10-150 mg QHS
Nortriptyline 10-50 mg QHS

Question 3

Anticonvulsant drug doses

Answer 3

Gabapentin 100-300 mg PO QHS or Q8H

Pregabalin 25-150 mg PO Q12H or Q8H

Question 4

SNRI drug doses

Answer 4

Venlafaxine XR 37.5-75 mg PO daily, titrate after 4-7 days, takes 4-6 weeks to take effect

Duloxetine 30-60 PO QD, take in the morning, titrate after 4-7 days, takes 4-6 weeks to take effect

Question 5

Anesthetic drug doses

Answer 5

Mexiletine 150 mg PO Q12H or Q8H
Lidocaine (see card)
Ketamine (see card)
Topical capsaicin 0.025 or 0.075% QID
Topical EMLA (lidocaine/prilocaine) - generally used for local procedures

Question 6

Common bony pain adjuvants

Answer 6

Steroids
NSAIDs
?Bisphosphonates
Radiation therapy, especially if pain improves with steroids

Question 7

Steroid doses when used as adjuvant therapy

Answer 7

Dexamethasone 2-10 mg PO/IV BID, TID, or QID

Dosages I’ve seen: 4 mg Q6H, 8 mg Q8H or Q12H

Question 8

NSAID doses when used as adjuvant therapy

Answer 8

High dose ibuprofen, 400-800 mg PO Q8H or Q6H; max dose 3200 mg / day

Topical diclofenac 1% QID (patch also available, applied BID)

Can also use ketorolac 30 mg PO/IV/SC Q6H

Question 9

Bisphosphonates when used as adjuvant therapy

Answer 9

Zolendronate 4 mg IV Q4 weeks

Can also use pamidronate

Question 10

Common visceral pain adjuvants

Answer 10

Steroids
Prokinetics (metoclopramide)
Antisecretory agents (octreotide)
?Benzodiazepines
Nerve blocks

Question 11

Common bladder spasm adjuvant

Answer 11

Oxybutynin 5-10 mg PO Q8H

Question 12

Common rectal spasm adjuvant

Answer 12

Belladonna+opium suppository, max 4 / day

Question 13

Prokinetic doses when used as adjuvant therapy

Answer 13

Metoclopramide 5-10 mg PO/IV Q6H

Question 14

Antisecretory doses when used as adjuvant therapy

Answer 14

Octreotide 100 mcg SC/IV Q8H

Question 15

Ketamine

Question 16

Lidocaine