Pain Management - Treatment
Optimal treatment may involve not only the use of traditional analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and opiods, but may also include medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA receptor antagonists. By combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller doses of each medication can be used. Adjuvant drugs – including antihistamines and corticosteroids – are also available to enhance pain relief, treat concurrent symptoms and counteract side effects.
As we learn more about the biochemical and pathophysiologic mechanisms of pain, our knowledge enables us to develop targeted strategies for specific conditions. “Combination therapy is frequently the only effective approach for managing the complex array of chemical mediators and other contributors to the individual pain experience. As topical formulations are developed, they provide hope for more effective drug combinations, which fewer systemic adverse drug effects and drug-drug interactions.
Topical agents, used alone or in combination with other therapies, are proving to be both safe and effective in reducing pain and improving function in patients with a variety of neuropath if and non neuropathic pain states. Research indicates that topical analgesics create an efficacious option for adjuvant drug therapy, with minimal risk of significant systemic absorption and drug-drug interactions. For example, topical administration of SNAIDs offers the advantage of local enhanced drug delivery to affected tissues with a reduced incidence of systemic adverse effects, such as peptic ulcer disease, GI hemorrhage. Topically applied NSAIDs have a superior safety profile to oral formulations: GI adverse drug reactions are rare with topically applied NSAIDs, compared with a 15% incidence reported for oral NSAIDs.
Transdermal medications are also very useful options when patients are unable t0o take medication orally, and this route of administration can often eliminate the need for injectable therapy. Transdermal administration avoids first pass hepatic metabolism,. And is an excellent option in patients with fluctuating hepatic function.
The International Association for the Study of Pain defines a dermatome as “the sensory segmental supply to the skin and subcutaneous tissue.” Dermatome maps can be helpful in determining the most effective site of application for transdermal pain therapy.