Neuropharmacological basis for multimodal analgesia in chronic pain

@article{Patel2021NeuropharmacologicalBF,
  title={Neuropharmacological basis for multimodal analgesia in chronic pain},
  author={Ryan Patel and Anthony Henry Dickenson},
  journal={Postgraduate Medicine},
  year={2021},
  volume={134},
  pages={245 - 259}
}
ABSTRACT Managing chronic pain remains a major unmet clinical challenge. Patients can be treated with a range of interventions, but pharmacotherapy is the most common. These include opioids, antidepressants, calcium channel modulators, sodium channel blockers, and nonsteroidal anti-inflammatory drugs. Many of these drugs target a particular mechanism; however, chronic pain in many diseases is multifactorial and induces plasticity throughout the sensory neuroaxis. Furthermore, comorbidities such… 

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References

SHOWING 1-10 OF 195 REFERENCES

Combination pharmacotherapy for management of chronic pain: from bench to bedside

Combination pharmacotherapy for neuropathic pain: current evidence and future directions

TLDR
Future directions and proposes research strategies aimed at bridging current knowledge gaps, including safety, compliance and cost–effectiveness; discovering optimal drug combinations and dose ratios; comparing concurrent with sequential combination therapy; and combining more than two drugs are discussed.

Combination pharmacotherapy for the treatment of neuropathic pain in adults.

TLDR
A meta-analysis involving 386 participants from two studies demonstrated modest, yet statistically significant, superiority of a gabapentin + opioid combination over gababentin alone, however, this combination also produced significantly more frequent side effect-related trial dropouts compared to gabAPentin alone.

Tapentadol potentiates descending pain inhibition in chronic pain patients with diabetic polyneuropathy.

TLDR
Tapentadol's analgesic effect in chronic pain patients with DPN is dependent on activation of descending inhibitory pain pathways as observed by CPM responses.

A Dual Noradrenergic Mechanism for the Relief of Neuropathic Allodynia by the Antidepressant Drugs Duloxetine and Amitriptyline

TLDR
A peripheral neuroimmune component of antidepressant drugs that is relevant to their delayed therapeutic action against neuropathic pain is highlighted, which relies on the anti-neuroimmune action of chronic antidepressant treatment.

Descending pain modulation and chronification of pain

TLDR
Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced the understanding of brain circuits that modulate pain and suggest that diminished descending inhibition is likely to be an important element in determining whether pain may become chronic.

Combination of morphine with nortriptyline for neuropathic pain

TLDR
This trial suggests superior efficacy of a nortriptyline–morphine combination over either monotherapy with constipation, dry mouth, and somnolence as the most frequent adverse effects.

Epidural clonidine analgesia for intractable cancer pain. The Epidural Clonidine Study Group.

TLDR
This study confirms the findings from previous animal studies which showed the effective, potent analgesic properties of intraspinal alpha 2-adrenergic agonists and suggests that epidural clonidine may provide effective relief for intractable cancer pain, particular of the neuropathic type.

Pain phenotype as a predictor for drug response in painful polyneuropathy—a retrospective analysis of data from controlled clinical trials

TLDR
This post hoc analysis of 8 drugs with mainly nonselective actions on neuropathic pain mechanisms found limited usefulness of sensory phenotyping in pain as the basis for individualized treatment.
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