Overview of the pharmacological management of pain

Question 1

NSAID’s

Answer 1

Aspirin and Voltaren.

Question 2

Opioids

Answer 2

Tramadol, Pethidine hydrochloride, Oxycodone, Codeine phosphate, MS Contin.

Question 3

Combination drugs (opioids + NSAIDs or opioids + paracetamol)

Answer 3

Panadeine and Nurofen plus.

Question 4

Antidepressants

Answer 4

Amitryptaline, Tofranil and Doxepin.

Question 5

Anticonvulsants

Answer 5

Neurontin, Gabapentin and Lyrica.

Question 6

What type of pain is most effectively treated by the use of select anticonvulsants?

Answer 6

Neuropathic type pain

Question 7

What is the major problem that can arise when prescribing opioids for analgesia?

Answer 7

Tolerance and dependency. CNS depression, thus respiratory depression if taken in excess.

Question 8

What are some of the indications for the use of anti-depressants in managing chronic pain?

Answer 8

• Arthritis
• Nerve damage from diabetes (diabetic neuropathy)
• Nerve damage from shingles (post-herpetic neuralgia)
• Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, radiculopathy)
• Tension headache
• Migraine
• Facial pain
• Fibromyalgia
• Low back pain, Pelvic pain.

Question 9

A recent Cochrane review assessed the evidence around efficacy and safety for 10 anticonvulsant drugs used to treat neuropathic pain and found evidence of efficacy for only 2, which two?

Answer 9

Gabapentin and pregabalin (both approved for treatment of neuropathic pain).

Gabapentin: E.g. Neurontin, Gralise, Horizant
Pregabalin: E.g. Lyrica