Analgesic therapy according to disease specific pathophysiology

Duck Mi Yoon

doi:10.5124/jkma.2011.54.7.739

J Korean Med Assoc > Volume 54(7); 2011 > Article

Yoon: Analgesic therapy according to disease specific pathophysiology

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2011; 54(7): 739-746.

Published online: July 13, 2011

DOI: http://dx.doi.org/10.5124/jkma.2011.54.7.739

Analgesic therapy according to disease specific pathophysiology

Duck Mi Yoon, MD

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Duck Mi Yoon, dmyoon@yuhs.ac

Received February 07, 2011 Accepted February 21, 2011

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This article reviews the pharmacologic management of osteoarthritis, low back pain, and neuropathic pain. In order to manage chronic pain appropriately, pharmacologic management, such as adequate drug selection, is the most important in clinical situations. Pain is classified as nociceptive, neuropathic, or mixed pain according to its mechanism. For effective pain control, we choose analgesics depending on adequate evaluation and understanding of the pathophysiology of pain. Nociceptive pain like osteoarthritis is controlled by acetaminophen, nonsteroidal antiinflammatory drugs, and opioids according to the pain intensity. However, our recommendation for neuropathic pain is antidepressants and anticonvulsants as first line treatments. Low back pain arises from nociceptive and neuropathic mechanisms, classified as mixed pain syndrome. Therefore, the rational management of low back pain targets the different mechanisms of pain by combining agents with different mechanisms of action.

Pain perception; Neuralgia; Drug therapy

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Table 1

Recommendations for neuropathic pain

TCA, tricyclic antidepressant; SSNRI, selective serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; NMDA, N-methyl-D-aspartate.