Analgesic adjuvant: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
Guo9810 (talk | contribs)
36 edits
added brief section on rationale behind using analgesic adjuncts
Guo9810 (talk | contribs)
36 edits
added more detail on specific classes of analgesic adjuncts
Line 1: Line 1:
{{Short description|Medication used for other purposes that additionally has analgesic effects}}
{{Short description|Medication used for other purposes that additionally has analgesic effects}}
{{Other uses|adjuvant}}
{{Other uses|adjuvant}}
An '''analgesic adjuvant''' is a [[medication]] that is typically used for [[Indication (medicine)|indication]]s other than [[pain]] control but provides control of pain in some painful [[disease]]s. For instance, [[caffeine]] has minimal [[analgesic]] effect on its own, but may have an adjuvant effect when given with [[paracetamol]] (acetaminophen).<ref>{{cite journal|pmid=11772146|year=2001|last1=Zhang|first1=W. Y.|title=A benefit-risk assessment of caffeine as an analgesic adjuvant|journal=Drug Safety|volume=24|issue=15|pages=1127–42|doi=10.2165/00002018-200124150-00004|s2cid=46300479}}</ref><ref>{{cite journal|doi=10.1002/psb.895|pmid=25502052|title=Caffeine as an analgesic adjuvant for acute pain in adults|journal=Prescriber|year=2012|volume=23|issue=7|page=41|last1=Derry|first1=C. J.|last2=Derry|first2=S.|last3=Moore|first3=R. A.|pmc=6485702}}</ref>
An '''analgesic adjuvant''' is a [[medication]] that is typically used for [[Indication (medicine)|indication]]s other than [[pain]] control but provides control of pain in some painful [[disease]]s. For instance, [[caffeine]] has minimal [[analgesic]] effect on its own, but may have an adjuvant effect when given with [[paracetamol]] (acetaminophen).<ref>{{cite journal|pmid=11772146|year=2001|last1=Zhang|first1=W. Y.|title=A benefit-risk assessment of caffeine as an analgesic adjuvant|journal=Drug Safety|volume=24|issue=15|pages=1127–42|doi=10.2165/00002018-200124150-00004|s2cid=46300479}}</ref><ref>{{cite journal|doi=10.1002/psb.895|pmid=25502052|title=Caffeine as an analgesic adjuvant for acute pain in adults|journal=Prescriber|year=2012|volume=23|issue=7|page=41|last1=Derry|first1=C. J.|last2=Derry|first2=S.|last3=Moore|first3=R. A.|pmc=6485702}}</ref>
== Rationale ==
⚫
Multimodal analgesia refers to the use of multiple classes of medications in order to treat pain from different [[Pain physiology|molecular mechanisms]] at once. Prolonged use of higher doses of opioids is associated with increased risk of [[Drug tolerance|tolerance]] and [[opioid use disorder]], so there is a growing trend in the use of multimodal analgesia to treat pain.<ref>{{Cite journal |last=Morgan |first=Michael M |last2=Christie |first2=MacDonald J |date=2011-10 |title=Analysis of opioid efficacy, tolerance, addiction and dependence from cell culture to human |url=https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/j.1476-5381.2011.01335.x |journal=British Journal of Pharmacology |language=en |volume=164 |issue=4 |pages=1322–1334 |doi=10.1111/j.1476-5381.2011.01335.x |issn=0007-1188 |pmc=PMC3229764 |pmid=21434879}}</ref><ref>{{Cite journal |last=Kaye |first=AlanDavid |last2=Urman |first2=RichardD |last3=Rappaport |first3=Yury |last4=Siddaiah |first4=Harish |last5=Cornett |first5=ElyseM |last6=Belani |first6=Kumar |last7=Salinas |first7=OrlandoJ |last8=Fox |first8=CharlesJ |date=2019 |title=Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings |url=https://journals.lww.com/10.4103/joacp.JOACP_51_18 |journal=Journal of Anaesthesiology Clinical Pharmacology |language=en |volume=35 |issue=5 |pages=40 |doi=10.4103/joacp.JOACP_51_18 |issn=0970-9185 |pmc=PMC6515722 |pmid=31142958}}</ref><ref>{{Cite journal |last=Olmos |first=Andrea V. |last2=Steen |first2=Sasha |last3=Boscardin |first3=Christy K. |last4=Chang |first4=Joyce M. |last5=Manahan |first5=Genevieve |last6=Little |first6=Anthony R. |last7=Lee |first7=Man-Cheung |last8=Liu |first8=Linda L. |date=2021-07-01 |title=Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department |url=https://bmjopenquality.bmj.com/content/10/3/e001320 |journal=BMJ Open Quality |language=en |volume=10 |issue=3 |pages=e001320 |doi=10.1136/bmjoq-2020-001320 |issn=2399-6641 |pmid=34281910}}</ref>


== Types of Analgesic Adjuvants ==
Examples include:


* [[Anticonvulsants]]
=== Anticonvulsants ===
** [[carbamazepine]], [[gabapentin]], [[pregabalin]]
⚫
* [[Antidepressants]]
** [[amitriptyline]],<ref>{{cite journal|title=Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states|first1=HM|last1=Bryson|first2=MI|last2=Wilde|date=1 June 1996|journal=Drugs & Aging|volume=8|issue=6|pages=459–476|pmid=8736630|doi=10.2165/00002512-199608060-00008}}</ref> [[duloxetine]], [[venlafaxine]]
* [[Antihistamines]]
** [[hydroxyzine]], [[promethazine]]
* [[Stimulants]]
** [[caffeine]], [[cocaine]], [[dextroamphetamine]], [[ephedrine]]


* [[Anticonvulsant|Anticonvulsants]] work through blockade of sodium and calcium ion channels to reduce glutamate (excitatory neurotransmitter) release.<ref>{{Cite journal |last=Kammerer |first=M. |last2=Rassner |first2=M. P. |last3=Freiman |first3=T. M. |last4=Feuerstein |first4=T. J. |date=2011-07 |title=Effects of antiepileptic drugs on GABA release from rat and human neocortical synaptosomes |url=http://link.springer.com/10.1007/s00210-011-0636-8 |journal=Naunyn-Schmiedeberg's Archives of Pharmacology |language=en |volume=384 |issue=1 |pages=47–57 |doi=10.1007/s00210-011-0636-8 |issn=0028-1298}}</ref>
* [[carisoprodol]]
* [[Neuropathic pain]] is the result of nociceptor hyper-excitability due to damage to neurons that transmit pain.
* [[cyclobenzaprine]]
* Common agents used are gabapentinoids (calcium channel blockers) and carbamazapine (sodium channel blocker).<ref>{{Cite journal |last=Sidhu |first=Harpreet S. |last2=Sadhotra |first2=Akshay |date=2016 |title=Current Status of the New Antiepileptic Drugs in Chronic Pain |url=https://www.frontiersin.org/articles/10.3389/fphar.2016.00276 |journal=Frontiers in Pharmacology |volume=7 |doi=10.3389/fphar.2016.00276/full |issn=1663-9812}}</ref>
* [[hyoscine]] (scopolamine)
** [[Gabapentin]]
** [[Pregabalin]]
** [[Carbamazepine]]: FDA-approved for trigeminal neuralgia<ref>{{Cite web |title=DailyMed - TEGRETOL- carbamazepine suspension TEGRETOL- carbamazepine tablet TEGRETOL XR- carbamazepine tablet, extended release |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8d409411-aa9f-4f3a-a52c-fbcb0c3ec053 |access-date=2023-11-08 |website=dailymed.nlm.nih.gov}}</ref>
* Some evidence that they may also help with inflammatory pain (nociceptor hyper-excitability due to damage to surrounding tissue)<ref>{{Cite journal |last=Tomić |first=Maja |last2=Pecikoza |first2=Uroš |last3=Micov |first3=Ana |last4=Vučković |first4=Sonja |last5=Stepanović-Petrović |first5=Radica |date=2018-12-01 |title=Antiepileptic drugs as analgesics/adjuvants in inflammatory pain: current preclinical evidence |url=https://www.sciencedirect.com/science/article/pii/S0163725818301049 |journal=Pharmacology & Therapeutics |volume=192 |pages=42–64 |doi=10.1016/j.pharmthera.2018.06.002 |issn=0163-7258}}</ref>


⚫
=== Antidepressants ===
The exact mechanism of the [[anticonvulsant]]s carbamazepine, gabapentin, and pregabalin is unclear, but they are used to treat [[neuropathic pain]] with differing degrees of success.<ref>{{cite book|title=Drug Treatment in Urology|publisher=John Wiley & Sons, 2008|author1=Eardley, I|author2=Whelan, P |author3=Kirby, R |author4=Schaeffer, A |page=65|chapter=Drugs Used In The Treatment Of Interstitial Cystitis}}</ref>


* [[Antidepressant|Antidepressants]] act by modulating serotonin transmission.
[[Antiemetic]]s and medication to relieve [[constipation]] are two examples of non-adjuvant medication indications because these are used to treat [[side effect]]s and adverse effects.<ref name = who>{{cite web | url = http://apps.who.int/iris/bitstream/10665/44540/1/9789241548120_Guidelines.pdf | archive-url = https://web.archive.org/web/20130419040358/http://apps.who.int/iris/bitstream/10665/44540/1/9789241548120_Guidelines.pdf | url-status = dead | archive-date = April 19, 2013 | access-date = 21 August 2017 | date = 2012 | title = WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses |publisher = World Health Organization }}</ref>
* Descending serotonin pathways in spinal cord implicated in modulation of pain perception, especially in chronic pain.<ref>{{Citation |last=Chen |first=Jiatong (Steven) |title=Physiology, Pain |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK539789/ |work=StatPearls |access-date=2023-11-06 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30969611 |last2=Kandle |first2=Patricia F. |last3=Murray |first3=Ian V. |last4=Fitzgerald |first4=Lauren A. |last5=Sehdev |first5=Jasjit S.}}</ref>
* Common agents used are [[Serotonin–norepinephrine reuptake inhibitor|serotonin-norepinephrine reuptake inhibitors]] (SNRIs) and [[Tricyclic antidepressant|tricyclic antidepressants]] (TCAs)
** [[Duloxetine]], [[venlafaxine]], and [[amitriptyline]] are all FDA-approved for chronic musculoskeletal pain, peripheral neuropathy, and fibromyalgia)<ref>{{Cite web |date=2010 |title=Cymbalta (duloxetine hydrochloride) capsules |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022516lbl.pdf |access-date= |website=FDA Highlights of Drug Prescribing Information}}</ref><ref>{{Cite web |date=2017 |title=EFFEXOR XR® (venlafaxine Extended-Release) Capsules |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020699s107lbl.pdf |website=FDA Highlights of Prescribing Information}}</ref><ref>{{Cite web |title=Amitriptyline Hydrochloride Tablets, USP |url=https://www.accessdata.fda.gov/spl/data/0f12f50f-7087-46e7-a2e6-356b4c566c9f/0f12f50f-7087-46e7-a2e6-356b4c566c9f.xml |access-date=2023-11-08 |website=www.accessdata.fda.gov}}</ref>


== Rationale ==
=== Muscle Relaxants ===

⚫
Multimodal analgesia refers to the use of multiple classes of medications in order to treat pain from different [[Pain physiology|molecular mechanisms]] at once. Prolonged use of higher doses of opioids is associated with increased risk of [[Drug tolerance|tolerance]] and [[opioid use disorder]], so there is a growing trend in the use of multimodal analgesia to treat pain.<ref>{{Cite journal |last=Morgan |first=Michael M |last2=Christie |first2=MacDonald J |date=2011-10 |title=Analysis of opioid efficacy, tolerance, addiction and dependence from cell culture to human |url=https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/j.1476-5381.2011.01335.x |journal=British Journal of Pharmacology |language=en |volume=164 |issue=4 |pages=1322–1334 |doi=10.1111/j.1476-5381.2011.01335.x |issn=0007-1188 |pmc=PMC3229764 |pmid=21434879}}</ref><ref>{{Cite journal |last=Kaye |first=AlanDavid |last2=Urman |first2=RichardD |last3=Rappaport |first3=Yury |last4=Siddaiah |first4=Harish |last5=Cornett |first5=ElyseM |last6=Belani |first6=Kumar |last7=Salinas |first7=OrlandoJ |last8=Fox |first8=CharlesJ |date=2019 |title=Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings |url=https://journals.lww.com/10.4103/joacp.JOACP_51_18 |journal=Journal of Anaesthesiology Clinical Pharmacology |language=en |volume=35 |issue=5 |pages=40 |doi=10.4103/joacp.JOACP_51_18 |issn=0970-9185 |pmc=PMC6515722 |pmid=31142958}}</ref><ref>{{Cite journal |last=Olmos |first=Andrea V. |last2=Steen |first2=Sasha |last3=Boscardin |first3=Christy K. |last4=Chang |first4=Joyce M. |last5=Manahan |first5=Genevieve |last6=Little |first6=Anthony R. |last7=Lee |first7=Man-Cheung |last8=Liu |first8=Linda L. |date=2021-07-01 |title=Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department |url=https://bmjopenquality.bmj.com/content/10/3/e001320 |journal=BMJ Open Quality |language=en |volume=10 |issue=3 |pages=e001320 |doi=10.1136/bmjoq-2020-001320 |issn=2399-6641 |pmid=34281910}}</ref>
* Over-excitation of skeletal muscle can result in [[spasticity]] (increased muscle tone) and/or [[Spasm|muscle spasms]] (involuntary muscle contractions) which may contribute to pain<ref name=":0">{{Cite journal |last=Fudin |first=Jeffrey |last2=Mena |first2=Raouf |date=A Review of Skeletal Muscle Relaxants for Pain Management |title=Practical Pain Management |url=https://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/review-skeletal-muscle-relaxants-pain-management |journal=Practical Pain Management |volume=16 |issue=5}}</ref>
* Several different types of [[Muscle relaxant|muscle relaxants]] used for pain with different mechanisms of action.
** [[Cyclobenzaprine]]
** [[Methocarbamol]]
** [[Tizanidine]]
** [[Baclofen]]
** [[Carisoprodol]]: also active centrally and reduces perception of pain<ref name=":0" />
** [[Diazepam]]
* Often have sedating effect that contributes to analgesia and improved relaxation
* Some controversy over whether muscle relaxants are useful for acute musculoskeletal pain<ref>{{Cite journal |last=Schoonover |first=Julie |last2=Rubin |first2=Susan E. |date=2022-03 |title=Should Muscle Relaxants Be Used as Adjuvants in Patients With Acute Low Back Pain? |url=https://www.aafp.org/pubs/afp/issues/2022/0300/p221.html |journal=American Family Physician |language=en-US |volume=105 |issue=3 |pages=221–221 |issn=1532-0650}}</ref>

=== Alpha-2 Adrenergic Agonists ===

* Alpha-2 adrenergic agonists such as [[clonidine]] are traditionally used to treat hypertension by blocking sympathetic
* [[Clonidine]] has been shown to have some efficacy when treating both acute and chronic pain.<ref>{{Cite journal |last=Kumar |first=Anil |last2=Maitra |first2=Souvik |last3=Khanna |first3=Puneet |last4=Baidya |first4=Dalim Kumar |date=2014 |title=Clonidine for management of chronic pain: A brief review of the current evidences |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950462/ |journal=Saudi Journal of Anaesthesia |volume=8 |issue=1 |pages=92–96 |doi=10.4103/1658-354X.125955 |issn=1658-354X |pmc=3950462 |pmid=24665248}}</ref>

=== Other Pharmacologic Compounds ===
Many other classes of pharmacologic compounds have been been found to have analgesic potential in certain situations. Several compounds used as adjunctive analgesics include [[Antihistamine|antihistamines]] ([[hydroxyzine]], [[promethazine]]), [[Cannabinoid|cannabinoids]], [[NMDA receptor antagonist|NMDA receptor antagonists]] ([[ketamine]], [[memantine]]), [[scopolamine]], and caffeine.{{Needs citation|date=November 2023}}


==References==
==References==

Revision as of 03:07, 8 November 2023

For other uses, see adjuvant.

An analgesic adjuvant is a medication that is typically used for indications other than pain control but provides control of pain in some painful diseases. For instance, caffeine has minimal analgesic effect on its own, but may have an adjuvant effect when given with paracetamol (acetaminophen).[1][2]

Rationale

Multimodal analgesia refers to the use of multiple classes of medications in order to treat pain from different molecular mechanisms at once. Prolonged use of higher doses of opioids is associated with increased risk of tolerance and opioid use disorder, so there is a growing trend in the use of multimodal analgesia to treat pain.[3][4][5]

Types of Analgesic Adjuvants

Anticonvulsants

  • Anticonvulsants work through blockade of sodium and calcium ion channels to reduce glutamate (excitatory neurotransmitter) release.[6]
  • Neuropathic pain is the result of nociceptor hyper-excitability due to damage to neurons that transmit pain.
  • Common agents used are gabapentinoids (calcium channel blockers) and carbamazapine (sodium channel blocker).[7]
  • Some evidence that they may also help with inflammatory pain (nociceptor hyper-excitability due to damage to surrounding tissue)[9]

Antidepressants

Muscle Relaxants

Alpha-2 Adrenergic Agonists

  • Alpha-2 adrenergic agonists such as clonidine are traditionally used to treat hypertension by blocking sympathetic
  • Clonidine has been shown to have some efficacy when treating both acute and chronic pain.[16]

Other Pharmacologic Compounds

Many other classes of pharmacologic compounds have been been found to have analgesic potential in certain situations. Several compounds used as adjunctive analgesics include antihistamines (hydroxyzine, promethazine), cannabinoids, NMDA receptor antagonists (ketamine, memantine), scopolamine, and caffeine.[citation needed]

References

  1. ^ Zhang, W. Y. (2001). "A benefit-risk assessment of caffeine as an analgesic adjuvant". Drug Safety. 24 (15): 1127–42. doi:10.2165/00002018-200124150-00004. PMID 11772146. S2CID 46300479.
  2. ^ Derry, C. J.; Derry, S.; Moore, R. A. (2012). "Caffeine as an analgesic adjuvant for acute pain in adults". Prescriber. 23 (7): 41. doi:10.1002/psb.895. PMC 6485702. PMID 25502052.
  3. ^ Morgan, Michael M; Christie, MacDonald J (2011-10). "Analysis of opioid efficacy, tolerance, addiction and dependence from cell culture to human". British Journal of Pharmacology. 164 (4): 1322–1334. doi:10.1111/j.1476-5381.2011.01335.x. ISSN 0007-1188. PMC 3229764. PMID 21434879. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  4. ^ Kaye, AlanDavid; Urman, RichardD; Rappaport, Yury; Siddaiah, Harish; Cornett, ElyseM; Belani, Kumar; Salinas, OrlandoJ; Fox, CharlesJ (2019). "Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings". Journal of Anaesthesiology Clinical Pharmacology. 35 (5): 40. doi:10.4103/joacp.JOACP_51_18. ISSN 0970-9185. PMC 6515722. PMID 31142958.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  5. ^ Olmos, Andrea V.; Steen, Sasha; Boscardin, Christy K.; Chang, Joyce M.; Manahan, Genevieve; Little, Anthony R.; Lee, Man-Cheung; Liu, Linda L. (2021-07-01). "Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaesthesia department". BMJ Open Quality. 10 (3): e001320. doi:10.1136/bmjoq-2020-001320. ISSN 2399-6641. PMID 34281910.
  6. ^ Kammerer, M.; Rassner, M. P.; Freiman, T. M.; Feuerstein, T. J. (2011-07). "Effects of antiepileptic drugs on GABA release from rat and human neocortical synaptosomes". Naunyn-Schmiedeberg's Archives of Pharmacology. 384 (1): 47–57. doi:10.1007/s00210-011-0636-8. ISSN 0028-1298. {{cite journal}}: Check date values in: |date= (help)
  7. ^ Sidhu, Harpreet S.; Sadhotra, Akshay (2016). "Current Status of the New Antiepileptic Drugs in Chronic Pain". Frontiers in Pharmacology. 7. doi:10.3389/fphar.2016.00276/full. ISSN 1663-9812.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  8. ^ "DailyMed - TEGRETOL- carbamazepine suspension TEGRETOL- carbamazepine tablet TEGRETOL XR- carbamazepine tablet, extended release". dailymed.nlm.nih.gov. Retrieved 2023-11-08.
  9. ^ Tomić, Maja; Pecikoza, Uroš; Micov, Ana; Vučković, Sonja; Stepanović-Petrović, Radica (2018-12-01). "Antiepileptic drugs as analgesics/adjuvants in inflammatory pain: current preclinical evidence". Pharmacology & Therapeutics. 192: 42–64. doi:10.1016/j.pharmthera.2018.06.002. ISSN 0163-7258.
  10. ^ Chen, Jiatong (Steven); Kandle, Patricia F.; Murray, Ian V.; Fitzgerald, Lauren A.; Sehdev, Jasjit S. (2023), "Physiology, Pain", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30969611, retrieved 2023-11-06
  11. ^ "Cymbalta (duloxetine hydrochloride) capsules" (PDF). FDA Highlights of Drug Prescribing Information. 2010.
  12. ^ "EFFEXOR XR® (venlafaxine Extended-Release) Capsules" (PDF). FDA Highlights of Prescribing Information. 2017.
  13. ^ "Amitriptyline Hydrochloride Tablets, USP". www.accessdata.fda.gov. Retrieved 2023-11-08.
  14. ^ a b Fudin, Jeffrey; Mena, Raouf (A Review of Skeletal Muscle Relaxants for Pain Management). "Practical Pain Management". Practical Pain Management. 16 (5). {{cite journal}}: Check date values in: |date= (help)
  15. ^ Schoonover, Julie; Rubin, Susan E. (2022-03). "Should Muscle Relaxants Be Used as Adjuvants in Patients With Acute Low Back Pain?". American Family Physician. 105 (3): 221–221. ISSN 1532-0650. {{cite journal}}: Check date values in: |date= (help)
  16. ^ Kumar, Anil; Maitra, Souvik; Khanna, Puneet; Baidya, Dalim Kumar (2014). "Clonidine for management of chronic pain: A brief review of the current evidences". Saudi Journal of Anaesthesia. 8 (1): 92–96. doi:10.4103/1658-354X.125955. ISSN 1658-354X. PMC 3950462. PMID 24665248.{{cite journal}}: CS1 maint: unflagged free DOI (link)

External links

Look up adjuvant in Wiktionary, the free dictionary.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Analgesic_adjuvant&oldid=1184062440"