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Puig, Margarita (2005). Drug combinations in pain management. Paineurope, 1:4-5

December 22, 2009 | Filed Under: Latest Readings | Comments(0)

Discusses “multi-modal therapy” – combining 2 or more analgesics with different mechanisms in an effort to improve treatment efficacy while minimizing adverse events. Explains decision logic needed to produce drug interactions with additive, synergistic or antagonistic effects. Shows how isobolograms guide drug interaction decision making. Yet, notes that while in cancer pain, the combination of opioids and NSAIDs “slightly improves analgesia,” in CNCP – the subspecialty pain of interest here – “there are insufficient data demonstrating the advantages of analgesic drug combinations,” because “there are less inflammatory components and the pain mechanism of each case should be investigated to find the correct drug combination.” Dr. Adams Implications: This makes the use of multiple drugs a dead issue in chronic non-cancer pain since, “in chronic musculoskeletal pain… monotherapy is often the rule” and, our CNCP patients with neuropathic pain stated that the addition of “antidepressants, anticonvulsants and other adjuvants” simply complicated treatment by: (1) delaying restoration of function, (2) complicating the management of side effects and (3) creating risk of “paradoxical pain,” where random increases in pain amplitude and frequency have been seen in cancer patients on opioids. Our data clearly show that the more medications that are used, especially at the start of treatment, the greater the risk of “paradoxical pain.”

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