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KMID : 1037820130020010042
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Journal of Pain and Autonomic Disorders
2013 Volume.2 No. 1 p.42 ~ p.47
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Pharmacologic Management of Pain
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Kim Byoong-Joon
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Abstract
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Many different underlying causes of pain may express as different pain symptoms via different pathophysiological mechanisms. Approach for the treatment of pain should begin with defining the exact causes of pain and removing them through careful history taking and neurologic examination. Pharmacologic treatment of pain can be the first step but not the only way, and should be considered in combination with other treatment modalities if pain control is not successful. The first-line treatment recommended in various practical guidelines for pharmacologic pain management includes antidepressants (tricyclic antidepressants or serotoin norepinephrine reuptake inhibitors) and α2δ calcium channel blockers (gabapentin, pregabalin) with topical agents as adjuvant therapy in cases of local pain. For the patients with severe intractable pain and low risk of drug abuse, opioid analgesics can be used actively as a combination therapy even at the early stage of chronic pain. Opioid analgesics, however, have limited effects in long-term use and the risk of opioid overdose increases with increasing dose. The choice of medication in an individual patient depends on a number of factors, including the potential for side effects, comorbidities (depression, sleep), drug interactions, overdose or abuse, and cost. Future research must clarify the optimal use of existing medications. This review is the summary of the presentation at the annual symposium of Korean Association of Pain and Autonomic Disorders, focusing on the pharmacologic treatment of chronic neuropathic pain.
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KEYWORD
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Pain, Neuropathic pain, Pharmacologic therapy, Antidepressant, Anticonvulsant
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