SUMMARY Skill in performing peripheral and neuraxial blocks enables anesthesiologists to safely manage severe acute pain during and after surgery, pain associated with vaginal delivery, cancer pain, and some chronic pain conditions. Epidural and intrathecal catheter infusions of a local…
SUMMARY Anticonvulsants target a range of different molecular mechanisms, including voltage-gated sodium channels, the α 2 δ subunits of calcium channels, SV2A, K v 7 potassium channels, and AMPA. In some cases the exact mechanism of anticonvulsant action has not…
SUMMARY Anticonvulsant drugs provide meaningful pain relief for many patients with chronic pain. The exact mechanisms by which they exert their beneficial effects are not always known, although the most commonly used drugs appear to work through inhibition of voltage-gated…
SUMMARY This chapter provides information on the pharmacology, guidelines, recent individual quality randomized controlled trials (RCTs), and data regarding efficacy and safety from recent systematic reviews involving antidepressants and pain. Of particular interest in these studies are the clinical meaningfulness…
SUMMARY Simple analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are highly effective clinically. The introduction of cyclooxgenase-2–inhibitory NSAIDs (coxibs), selective inhibitors of cyclooxygenase-2, has resulted in large quantities of safety and efficacy data. Although there are differences in…
SUMMARY Antipyretic analgesics are among the most often used medications worldwide. Their major mechanism of action is blockade of the synthesis of prostanoids, which are lipid signaling molecules produced from arachidonic acid by two cyclooxygenases. Constitutive cyclooxygenase-1 (COX-1) and inducible…
SUMMARY The pain-relieving effect of opioids was acknowledged early in the history of medicine. However, their abuse potential and adverse effects have resulted in widespread “opiophobia,” a phenomenon of customary underutilization of opioids. The major barriers to appropriate opioid use…
SUMMARY Morphine has become the “gold standard” analgesic to which all others are compared. It is also one of the oldest drugs known. However, it is only in the past 30 years or so that the details of how opioids…
SUMMARY Clinical trials for acute and chronic pain can achieve high levels of precision if they adhere to some simple rules. This chapter discusses the various ways in which pain may be studied, how trials may be designed, and how…
SUMMARY The activity evoked in primary afferent fibers by high-intensity stimuli or tissue injury leads to a pattern of evoked spinal activity and then spinifugal outflow, which in turn activates supraspinal linkages. This review considers the multiple transmitter systems in…