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Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
In recent years, anti-convulsant drugs used to treat neuropathic pain have become substances of abuse. Between the years 2012 and 2016, there was a significant increase in deaths in England and Wales relating to pregabalin and gabapentin of 2775% and 738%, respectively (Office of National Statistics [ONS] 2019); subsequently, these substances have now become schedule 3 controlled drugs with further emphasis on avoiding inappropriate prescribing (Lacobucci 2017). Although gabapentinoids are still licensed in the management of neuropathic pain, other, less addictive and abused medicines such as amitriptyline- and duloxetine-type medications are as, or potentially more effective for managing neuropathic pain. Once commenced, all of these drugs can take up to 6 weeks to have a full effect, and will require good compliance, therefore, quality counselling should be carried out between the prescriber and the individual at the time of commencing, alongside regular reviews.
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The gabapentinoids have been shown to be effective in a number of chronic peripheral and central neuropathic pain states including postherpetic neuralgia, diabetic polyneuropathy, mixed neuropathic pain, and spinal cord injury pain (Finnerup et al, 2015).
Musculoskeletal/injuries
Published in Gina Johnson, Ian Hill-Smith, Chirag Bakhai, The Minor Illness Manual, 2018
Gina Johnson, Ian Hill-Smith, Chirag Bakhai
There is increasing awareness that the gabapentinoids have significant potential for misuse, dependence and drug diversion. Pregabalin is likely to have a higher abuse potential due to its rapid absorption, faster onset of action and higher potency. Public Health England (2014) advises prescribers to inform patients of the risks of abuse and dependence, and that the rationale for prescribing decisions be discussed fully and documented. The Advisory Council on the Misuse of Drugs recommended to the government in 2016 that the drugs should be controlled as Class C substances. At the time of publication, this has not yet been implemented although it has been accepted in principle, subject to consultation.
Misuse of gabapentinoids (pregabalin and gabapentin) in patients with neuropathic pain related to spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Cemile Sevgi Polat, Hatice Ecem Konak, Meltem Günes Akıncı, Sule Sahin Onat, Elif Umay Altas
Chronic pain after spinal cord injury (SCI) is a common and important problem.1 This pain observed in patients with SCI may be nociceptive or neuropathic. Neuropathic pain (NP) results from a damage to or dysfunction of the nervous system and is seen in approximately 50% of patients after SCI.1,2 Neuropathic pain causes sleep disturbance and depression in patients with SCI and decreases quality of life.1 Neuropathic pain is a challenging condition to treat since its underlying mechanisms are not fully understood.3 Gabapentinoids (GPs) are considered among the first-line treatment options for NP due to SCI.2,4 Gabapentinoids are antiepileptic drugs and are structural analogs of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. It is believed that GPs exert their therapeutic efficacy in NP by binding to the alpha-2/delta subunit of voltage-gated calcium channels, reducing calcium flow and subsequently neurotransmitter release.5 Gabapentinoids were shown to be effective in the treatment of NP due to SCI,6 however, accounts regarding the misuse of GPs have been reported.7–9 The mechanism of gabapentinoid misuse is not fully understood. Although they do not bind directly to GABA receptors, they are thought to use GABA-mimetic properties. The direct and indirect effects of GPs on the dopaminergic reward system are thought to be related to misuse. The reason for the misuse of GPs is explained by their euphoric effects and dissociative properties.7
Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions
Published in Baylor University Medical Center Proceedings, 2023
Nicholas F. Lombana, Ishan M. Mehta, Caiwei Zheng, Reuben A. Falola, Andrew M. Altman, Michel H. Saint-Cyr
Originally developed as an anticonvulsant, gabapentinoids act centrally via calcium channels, inhibiting the release of pain modulators.39 They have proven to be useful adjuncts in ERAS protocols and effective at controlling chronic and acute postoperative pain.39 These drugs have also shown promise when started preoperatively on a scheduled basis.39 Although gabapentin has been shown to independently decrease postoperative opioid consumption and pain scores, there are risks of prolonged somnolence and respiratory depression in the PACU.41,42 Antispasmodics, such as cyclobenzaprine and methocarbamol, decrease patient pain and discomfort by inhibiting postoperative muscle contraction through antimuscarinic effects.40 The incorporation of all of these medications into ERAS protocols has shown promise in reducing LOS, postoperative pain, and opioid consumption.2,7,8
Evaluating oliceridine as a treatment option for moderate to severe acute post-operative pain in adults
Published in Expert Opinion on Pharmacotherapy, 2022
Zhaosheng Jin, Mingxi Zhu, Abhishek Gupta, Christopher Page, Tong J Gan, Sergio D Bergese
While the use of regimented non-opioid analgesics can significantly reduce postoperative opioid requirement, the therapeutic option can be limited by the effects and contraindications associated with the various non-opioid analgesics. For example, nonselective NSAIDs are associated with gastrointestinal toxicity, renal dysfunction, and drug-induced asthma [16]. NSAIDs may be contraindicated in patients with preexisting renal insufficiency, gastrointestinal bleeding, or severe asthma. Selective COX-2 inhibitors, on the other hand, are associated increased thrombotic risks such as myocardial infarction and stroke [17]. Acetaminophen, while usually well tolerated, can result in irreversible liver injury with overdose or when used in patients with advanced liver disease [18]. Adverse effects of gabapentinoids include dizziness, sedation, and cognitive difficulties. The Food and Drug Administration (FDA) issued a black box warning with concerns that gabapentinoids, in combination with other central nervous system depressants such as opioids, could precipitate respiratory depression in at-risk patients [19]. While lidocaine infusion is an effective analgesic adjunct, its administration is limited by the risk of local anesthetic systemic toxicity [75].