Nonopioid Analgesics, Adjuvants, and Antidepressants

When treating acute and chronic pain conditions, there is a need for “balanced” analgesia or multimodal analgesia. These are cases in which opioids as monotherapy are rarely appropriate. The therapeutic role of adjuvant analgesics is to increase the therapeutic index of opioids by producing an opioid-sparing effect. The use of nonopioid analgesics, adjuvant agents, and, in some cases antidepressants, may provide additional pain relief by opioid-sparing effects. Many of these agents have additional benefits in treating other related comorbid conditions present in those who suffer from chronic pain. Newer regulatory guidelines, like the CDC Guideline for Prescribing Opioids for Chronic Pain, recommend that first-line treatment for acute and chronic pain should be nonopioid analgesics as an initial trial, emphasizing the need to optimize multimodal analgesia including nonpharmacologic interventions to improve outcomes. It is vital to have an appreciation and knowledge of alternative pain treatments in an era where mass opioid use has been the norm. During the so-called opioid epidemic, practitioners should provide patients with effective tools to help manage pain while minimizing the negative effects of opioid exposure. Adjuvant agents are not primarily identified as analgesic in nature but have been found in clinical practice to have either an independent analgesic effect or additive analgesic properties when used with opioids. Adjuvants add a unique action in opioid-resistant pain and can play a role in reducing opioid side effects. Knowledge of this class of medications is critical for the prescriber to be able to document their thought process in treatment plan development in the event of regulatory review. The goal of this course is to provide you with the tools to successfully evaluate the appropriate role of these agents in your practice. (Recorded at PAINWeek 2018)