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Introduction to adjuvant analgesics Introduction to adjuvant analgesics
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General considerations General considerations
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Comprehensive assessment Comprehensive assessment
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Positioning of treatment Positioning of treatment
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Pharmacological characteristics Pharmacological characteristics
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Interindividual and intraindividual variability Interindividual and intraindividual variability
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Risks and benefits of polypharmacy Risks and benefits of polypharmacy
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Adjuvant analgesics Adjuvant analgesics
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Multipurpose analgesics Multipurpose analgesics
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Antidepressant drugs Antidepressant drugs
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Tricyclic antidepressants Tricyclic antidepressants
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SNRIs SNRIs
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SSRIs SSRIs
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Others Others
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Corticosteroids Corticosteroids
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Alpha-2 adrenergic agonists Alpha-2 adrenergic agonists
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Neuroleptics Neuroleptics
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Adjuvant analgesics used for neuropathic pain Adjuvant analgesics used for neuropathic pain
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Anticonvulsant drugs Anticonvulsant drugs
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Oral and parenteral sodium channel blockers Oral and parenteral sodium channel blockers
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N-methyl-D-aspartate receptor blockers N-methyl-D-aspartate receptor blockers
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Cannabinoids Cannabinoids
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Baclofen Baclofen
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Topical analgesics Topical analgesics
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Adjuvant analgesics used for bone pain Adjuvant analgesics used for bone pain
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Calcitonin and bisphosphonates Calcitonin and bisphosphonates
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Radiopharmaceuticals Radiopharmaceuticals
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Adjuvant analgesics used for bowel obstruction Adjuvant analgesics used for bowel obstruction
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Anticholinergic drugs Anticholinergic drugs
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Octreotide Octreotide
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Corticosteroids Corticosteroids
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Adjuvant analgesics used for musculoskeletal pain Adjuvant analgesics used for musculoskeletal pain
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Muscle relaxants Muscle relaxants
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Conclusions Conclusions
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References References
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Online references Online references
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Cite
Abstract
In the management of pain associated with serious illness, ‘adjuvant analgesics’ usually are administered in concert with opioid therapy in an effort to improve outcomes when an opioid does not provide satisfactory relief with tolerable side effects. They may be divided into categories, including multipurpose drugs, and drugs used selectively for neuropathic pain, bone pain, pain due to bowel obstruction, or musculoskeletal pain. These drugs are selected for a trial based on limited data available and clinical experience; sequential trials may be undertaken when pain is refractory. Multipurpose drugs may be considered for any type of pain. The most useful include corticosteroids and analgesic antidepressants. For neuropathic pain, conventional first-line agents are gabapentinoids, analgesic antidepressants, and corticosteroids. Corticosteroids and bisphosphonates, are used commonly for bone pain. The indications and dosing strategies for these drugs are evolving as scientific evidence and clinical experience accumulate.
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