introduction to pharmacological pain management

• central - modulation

  Neurotransmitters involved in descending pain inhibition:

  • 5-HT or 5-hydroxytryptamine (old name is serotonin)
  • Endorphins 
  • Enkephalins
  • Norepinephrine (NE)(old name is noradrenaline)
  • GABA (gamma-aminobutyric acid)
• approaches to pain management

  • Analgesics
  • Conventional - aspirin to morphine
  • Unconventional - antidepressant, anticonvulsant, and others
  • Block nerve transmission
  • Reversible - local anesthetic + steroid
  • Irreversible - surgery and nerve destruction 
  • Alternatives
  • stimulators
  • acupuncture
  • hypnosis
  • psychology
• analgesics

  The WHO Analgesic Ladder is widely regarded as being the best approach to the management of pain, whatever its origin.

  The objective of treatment in all types of pain, irrespective of origin, is to achieve symptom control and improve the patient’s quality of life
• What are adjuvant analgesics also called?

  Co-analgesics
• What is the primary use of adjuvant analgesics?

  They are not primarily used for analgesia
• How do adjuvant analgesics differ from typical analgesics?

  They have independent analgesic properties effective in some conditions
• In what situations might adjuvant analgesics be administered?

  Alone or with NSAIDs and Opioids
• What is one potential benefit of using adjuvant analgesics with NSAIDs or opioids?

  They can enhance or complement the analgesic activity
• For what type of pain might adjuvant analgesics have independent analgesic activity?

  Neuropathic pain
• How can adjuvant analgesics affect the side effects of NSAIDs or opioids?

  They may counteract the side effects
• How can adjuvant analgesics enhance analgesia from opioids?

  By enhancing the overall analgesic effect
• What symptoms might adjuvant analgesics help manage that increase pain?

  Symptoms that exacerbate pain
• What are antidepressants indicated for?

  Treating mental health conditions such as major depressive disorder and anxiety disorders
• How do antidepressants help alleviate symptoms of depression and anxiety?

  They increase the activity of neurotransmitters in the brain
• Which neurotransmitters are commonly increased by antidepressants?

  Serotonin, norepinephrine, and dopamine
• What are some common examples of Selective Serotonin Reuptake Inhibitors (SSRIs)?

  • Citalopram (Cipramil)
  • Dapoxetine (Priligy)
  • Escitalopram (Cipralex)
  • Fluoxetine (Prozac or Oxactin)
  • Fluxoxamine (Faverin)
  • Paroxetine (Seroxat)
  • Sertraline (Lustral)
  • Vortioxetine (Brintellix)
• What are some common examples of Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)?

  • Duloxetine (Cymbalta and Yentreve)
  • Venlafaxine (Efexor)
• What are some common side effects of antidepressants?

  Dry mouth, blurred vision, weight gain, dizziness, and headaches
• What is akathisia in relation to antidepressant side effects?

  It is a feeling of agitation and uncontrolled restlessness
• What does emotional blunting refer to as a side effect of antidepressants?

  Limited emotional reactivity and feeling numb to both positive and negative emotions
• What is a common sexual dysfunction side effect of antidepressants?

  Erectile dysfunction
• What gastrointestinal side effects can occur with antidepressant use?

  Diarrhoea and nausea
• What are anticonvulsants also known as?

  Antiseizure medications
• What conditions do anticonvulsants help treat?

  Epilepsy, seizures, anxiety, bipolar disorder, and neuropathic pain
• How are anticonvulsants particularly helpful for nerve damage?

  They help with burning and shooting pain
• How do anticonvulsants work in the body?

  They change the way nerves send messages to the brain
• What additional effects do anticonvulsants have besides treating seizures?

  They act as mood stabilizers and help with sleep
• What are some commonly used anticonvulsant drugs?

  • Clonazepam
  • Lamotrigine
  • Divalproex
  • Topiramate
  • Gabapentin
  • Pregabalin
  • Levetiracetam
  • Sodium valproate
  • Carbamazepine
• What are common side effects of anticonvulsants?

  Nausea, drowsiness, dizziness, lack of energy, agitation, irritability, anxiety, mood changes, abdominal pain, weight gain, change in appetite, dry mouth, abnormal movements
• What types of abnormal movements can occur as side effects of anticonvulsants?

  Writhing, jerking, stiffness, and tremor
• What are corticosteroids a man-made version of?

  Hormones released by the adrenal cortex
• What types of corticosteroids are included in this category?

  Glucocorticoids and mineralocorticoids
• How do corticosteroids reduce pain?

  By reducing inflammation and oedema associated with tumours and damaged nerves
• What conditions can corticosteroids treat?

  • Asthma
  • COPD
  • Hay fever
  • Hives
  • Eczema
  • Arthralgia
  • Myalgia
  • Sciatica
  • IBS
  • Lupus
  • RA
  • Multiple sclerosis
• Name a common corticosteroid drug.

  Dexamethasone
• What is another common corticosteroid drug?

  Prednisolone
• What is a third common corticosteroid drug?

  Beclomethasone
• What is a fourth common corticosteroid drug?

  Fluticasone
• What are corticosteroids a man-made version of?

  Hormones released by the adrenal cortex
• What is a fifth common corticosteroid drug?

  Methylprednisolone