| Title | Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. | | Author(s) | Kroenke K, Krebs EE, Bair MJ | | Institution | Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. kkroenke@regenstrief.org | | Source | Gen Hosp Psychiatry 2009 May-Jun; 31(3):206-19. | | MeSH | Acetaminophen
Amines
Analgesics
Analgesics, Opioid
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Anxiety Disorders
Aspirin
Chronic Disease
Cyclohexanecarboxylic Acids
Depressive Disorder
Guidelines as Topic
Humans
Pain
Somatoform Disorders
Tramadol
gamma-Aminobutyric Acid
| | Abstract | OBJECTIVES: Chronic pain is one of the most prevalent, costly and disabling conditions in both clinical practice and the workplace, yet often remains inadequately treated. Moreover, chronic pain commonly co-occurs with depression, anxiety and somatoform disorders, and adversely affects response of these conditions to psychiatric treatments. This article provides an evidence-based approach to the pharmacotherapy of chronic pain.
METHODS: This narrative review is derived largely from meta-analyses and systematic reviews published since 2005. For a few medications, findings from multiple recent trials are synthesized if a systematic review had not yet been published. Classes of medications are first reviewed, followed by an overview of four common pain disorders: neuropathic pain, low back pain, fibromyalgia and osteoarthritis.
RESULTS: A stepped care approach based upon existing evidence includes (1) simple analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs); (2) tricyclic antidepressants (if neuropathic, back or fibromyalgia pain) or tramadol; (3) gabapentin, duloxetine or pregabalin if neuropathic pain; (4) cyclobenzaprine, pregabalin, duloxetine, or milnacipran for fibromyalgia; (5) topical analgesics (capsaicin, lidocaine, salicylates) if localized neuropathic or arthritic pain; and (6) opioids. Disease-specific recommendations for neuropathic, low back, fibromyalgia and osteoarthritis pain are reviewed.
CONCLUSIONS: A number of medications have proven effective in chronic pain disorders and their use individually or in combination should improve the management of chronic pain. | | Language | eng | | Pub Type(s) | Journal Article
Meta-Analysis
Review
| | PubMed ID | 19410099 |
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