Pharmacologic Management Of Pain


Pharmacologic Management Of Pain

What is pharmacologic pain management?

The focus of pharmacologic pain management is on alleviating your pain symptoms by administering prescription (Rx) or over-the-counter (OTC) medications.

What are the pharmacological examples of pain relief?

What are the different types of pain-relief medicines? – As everyone’s experience of pain is different, individuals need different ways to help manage their pain. Different pain-relief options suit particular circumstances, as well. Over-the-counter (OTC) medicines include:

paracetamol non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin or diclofenac gels and creams containing medicines — such as NSAIDs and capsaicin — that are absorbed through your skin (topical medicines)

Your doctor may also recommend a prescription medicine, such as:

anti-epileptic medicines, such as pregabalin, gabapentin or carbamazepine antidepressants, such as amitriptyline or duloxetine opioids, for example codeine, morphine or tramadol other types of medicine that treat the cause of your pain, such as muscle relaxants or corticosteroids.

There are also many ways to reduce pain that don’t involve medicines, such as stress management, meditation or exercise, Talk to your GP about which alternatives may be useful for you. LOOKING FOR A MEDICINE? — Search for specific generic or brand-name medications and learn how to take your medicines safely.

What is non pharmacologic pain management?

What is non-pharmacological pain management? – Non-pharmacological pain management is the management of pain without medications. This method utilizes ways to alter thoughts and focus concentration to better manage and reduce pain. Methods of non-pharmacological pain include:

What is the pharmacological management of breakthrough pain?

Management – Effective management of breakthrough pain often entails an interdisciplinary and multimodal approach. Early clinical intervention with pharmacologic therapy is the foundation of breakthrough-pain treatment and can be instrumental in enhancing patients’ QoL and productivity.15 Optimal management of breakthrough pain calls for a thorough evaluation of the patient, including the pain etiology, factors that may trigger or exacerbate pain, and ongoing reassessment of the patient’s response to the selected pain-management strategy.15 Clinicians should also assess how breakthrough pain affects a patient’s productivity and QoL and tailor management to individual need.

Factors that are often considered include the patient’s medical and medication history; prior analgesic use and response; severity, duration, and frequency of breakthrough pain; and treatment preferences.15,17 Prescribers should also consider patients’ risk factors for possible addiction, abuse, and misuse.15,17 In May 2019, the U.S.

Department of Health and Human Services’ Pain Management Best Practices Inter-Agency Task Force published a report on pain management that stressed the significance of implementing a patient-centered approach to diagnosis and treatment of acute and chronic pain and the value of tailoring therapy to patient need.18 The report emphasizes the importance of developing an effective pain-treatment plan following proper evaluation to establish a diagnosis, with detectable outcomes that focus on improvements such as QoL, enhanced functionality, and activities of daily living.18 Multiple publications recommend as-needed (PRN) use of a short-acting opioid as the ideal approach to managing breakthrough pain when no contraindications are present.19-21 For example, Portenoy and colleagues note that because of the increased occurrence of breakthrough pain in patients with cancer and the numerous negative clinical consequences, a therapeutic approach known as rescue dosing is extensively employed.19 An Oxford University Press textbook on cancer-related breakthrough pain considers short-acting opioids the rescue medication of choice for managing breakthrough pain.15 Other recommended nonopioid strategies include the use of nonsteroidal anti-inflammatory drugs and the avoidance of triggers when feasible.15 The rescue dose is separate from the fixed-schedule opioid-analgesic regimen, and it typically entails the use of one of the single-entity oral opioid formulations, such as immediate-release morphine, oxycodone, hydromorphone, or oxymorphone.19 In general, the dose of short-acting opioids for breakthrough pain ranges from approximately 5% to 15% of the total 24-hour scheduled opioid dose.19,21-23 The clinician should regularly reassess patients and make dosing adjustments as warranted, based on response.19-21 If feasible, clinicians should prescribe the same pharmacologic class for both long-acting (24-hour scheduled doses) and short-acting (PRN doses for relief of breakthrough pain) opioid analgesics.21 The NCI states that rapid-acting oral, buccal, sublingual, transmucosal, rectal, and intranasal products are appropriate for treating breakthrough pain when no contraindications exist.24 Breakthrough pain may also be managed with rapid-onset transmucosal fentanyl formulations, which are specifically indicated for managing breakthrough pain in adults with cancer who are already receiving and tolerate around-the-clock opioid therapy for underlying cancer pain ( TABLE 2 ).19 The agent should be initiated at the lowest dose and titrated to effect according to its prescribing information.19,25-29 Prescribers should be aware that all transdermal fentanyl products, including generics, require adherence to the agent’s shared Risk Evaluation and Mitigation Strategy (REMS) program; enrollment in the REMS program is mandatory and is intended to lessen the risk of misuse/abuse and unintentional overdose.19,25-29 Clinicians should also consider the patient’s risk factors for addiction, abuse, and misuse.25-29 When opioid therapy is no longer necessary, clinicians should consider discontinuing these agents, along with a gradual decrease in other opioids, to lessen possible withdrawal effects.25-29

What is the difference between pharmacologic and non pharmacologic pain relief?

INTRODUCTION – Pain management among neonates presents a challenge to clinical practice. Although neonates are able to process nociceptive stimuli, painful procedures are commonly performed in neonatal care units without adequate treatment. ( 1 ) Repeated and untreated pain experiences during hospitalization at such early stages of life might lead to neurodevelopmental and behavioral damage, with detrimental consequences over both the short and long term.

  1. 2, 3 ) Avoiding painful interventions should be the best strategy to manage neonatal pain.
  2. However, numerous diagnostic and therapeutic procedures are needed in neonatal intensive care units (ICUs) because they promote the stability and clinical recovery of the neonate; thus, this environment is hostile to the neonate and his or her family.
You might be interested:  Neck Pain Homeopathic Medicine

In addition, frequent handling and excessive light and noise increase the amplitude of the initial painful stimulus, which can negatively affect the clinical outcome. Thus, neonates must be spared from interventions whose benefits do not outweigh the harmful effect inherent to the procedure.

  • 4 – 6 ) The multidisciplinary team, especially the nursing team, is responsible for the use of neonatal pain-relief strategies.
  • Thus, assessing, preventing, and managing pain are important actions and should be considered during care through the adoption of pharmacological and nonpharmacological strategies.

( 7 ) Despite evidence of the deleterious effects of pain among neonates and the efficacy of pharmacological and nonpharmacological pain-relief strategies, recently published national studies have confirmed that analgesic measures are infrequently implemented in neonatal ICUs.

( 4, 8, 9 ) Pharmacological strategies consider the use of drugs to treat and relieve pain. ( 10 ) Nonpharmacological strategies favor other modalities of care, especially during the modulation stage of the painful experience. ( 7, 10, 11 ) Internationally established protocols subsidize the efficacy and safety of using these strategies among neonates.

( 12, 13 ) Given that the management of neonatal pain remains a challenge for healthcare practitioners, the present study aimed to describe and quantify the pharmacological and nonpharmacological strategies used to relieve pain and promote neonate comfort during their hospitalization in neonatal ICUs.

What are the benefits of pharmacological pain management?

These potential benefits include: better control of pain, which may improve how you feel and function physically; an increased ability to function in personal and professional relationships, as well as an improved sense of overall well-being; and or a decrease in the intensity of pain.

What is the most common pain relief drug?

Over-the-counter (OTC) pain relievers can help relieve pain or lower a fever. Over-the-counter means you can buy these medicines without a prescription. The most common types of OTC pain medicines are acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Pain medicines are also called analgesics.
  • Each kind of pain medicine has benefits and risks.
  • Some types of pain respond better to one kind of medicine than to another kind.
  • What takes away your pain might not work for someone else.
  • Taking pain medicines before exercising is OK.
  • But do not overdo the exercise just because you have taken the medicine.

Read labels to learn how much medicine you or your child can take at one time and during the whole day. This is known as the dosage. Talk to your pharmacist or your child’s health care provider if you are not sure about the correct amount. Do not give children medicine that is meant for adults.

If you take pain relievers on most days, tell your provider. You may need to be watched for side effects.Do not take more than the amount recommended on the container or more than your provider tells you to take.Read the warnings on the label before taking the medicine.Store medicine safely and securely, Check the dates on medicine containers to see when you should throw them away.

ACETAMINOPHEN Acetaminophen (Tylenol) is a non-aspirin pain reliever. It is NOT an NSAID, which is described below.

Acetaminophen relieves fever and headaches, and other common aches and pains. It does not relieve inflammation.This medicine does not cause as many stomach problems as other pain medicines do. It is also safer for children. Acetaminophen is often recommended for arthritis pain because it has fewer side effects than other pain medicines.Examples of OTC brands of acetaminophen are Tylenol, Paracetamol, and Panadol.Acetaminophen prescribed by a provider is usually a stronger medicine. It is often combined with a narcotic ingredient.


Adults should not take more than 3 grams (3,000 mg) of acetaminophen in a single day. Large amounts can harm your liver. Remember that 3 grams is about the same as 6 extra-strength pills (500 mg each) or 9 regular pills (325 mg each).People with liver disease should usually not take more than 2 grams (2,000 mg) of acetaminophen in a single day. Check with your provider for guidance on what is safe for you.If you are also taking pain medicine prescribed by your provider, talk to your provider or pharmacist before taking any OTC acetaminophen.For children, follow package instructions for the maximum amount your child can have at one time and in a single day. Call your child’s provider if you are not sure about the instructions.


Aspirin and NSAIDs relieve fever and pain. They also reduce swelling from arthritis or a muscle sprain or strain.When taken for a short time (no longer than 10 days), aspirin and NSAIDs are safe for most people. They can cause stomach upset or even ulcers in some people.Children under age 18 years should not take aspirin due to a risk for Reye syndrome.Some NSAIDs can be bought over the counter, such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).Other NSAIDs are prescribed by your provider.


DO NOT give aspirin to children under 18 years of age, Reye syndrome can occur when aspirin is used to treat children who have viral infections, such as chickenpox or the flu.

Talk to your provider or pharmacist before using aspirin or any over-the-counter NSAID if you:

Have heart disease, high blood pressure, kidney disease, liver disease, or stomach or digestive tract bleeding.Take other medicines, especially blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), apixiban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto).Are taking NSAIDs prescribed by your provider, including celecoxib (Celebrex), nabumetone (Relafen), or others.

Medicines for pain non-narcotic; Drugs for pain non-narcotic; Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine – over-the-counter; Pain medicine – OTC Aronson JK. Non-steroidal anti-inflammatory drugs (NSAIDs). In: Aronson JK, ed.

Meyler’s Side Effects of Drugs,16th ed. Waltham, MA: Elsevier; 2016:236-272. Dinakar P. Pain management. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice,8th ed. Philadelphia, PA: Elsevier; 2022:chap 52. House SA. Pain. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds.

Conn’s Current Therapy 2023, Philadelphia, PA: Elsevier 2023:35-42. Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.

You might be interested:  Causes Of Epigastric Pain

What are 3 non-pharmacological ways to manage pain?

5. Conclusion – The role of non-pharmacological approaches to pain management is evolving, and some non-pharmacological and complementary therapies have an increasingly important contribution to make to holistic patient care alongside analgesics. Generally, these approaches are relatively inexpensive with high safety profile and low side effects.

  • There is evidence to support the use of patient education, cognitive behavioral therapy (CBT), relaxation, music, and other modalities.
  • These therapies should be taken into consideration to help and support the standard pharmacological treatment in pain management.
  • While medical drugs are essentially being used for treating the somatic (physiological and emotional) dimension of the pain, non-pharmacological therapies aim to treat the cognitive, affective, behavioral and socio-cultural dimensions of the pain.

These therapies can treat the pain as adjuvant or complementary at middle level and severe pain experiences. Non-pharmacological approaches help to

  • Increase the individual ability to control feeling.
  • Reduce the feeling of weakness.
  • Enhance the functional capacity and activity level.
  • Reduces anxiety and stress.
  • Decrease the pain behavior and focused pain level.
  • Decrease the dosage of analgesic drugs, subsequently decreasing the well-known side effects of these drugs.

For this reason, research on non-pharmacological approaches to pain management is very important, so that patients are provided with information that ensures them the most effective options for treating their pain.

Which is the first line drug used for pain management?

Acetaminophen – Acetaminophen is usually recommended as a first line treatment for mild to moderate pain. It might be taken for pain due to a skin injury, headache, or conditions that affect the muscles and bones. Acetaminophen is often prescribed to help manage osteoarthritis and back pain. It also may be combined with opioids to reduce the amount of opioid needed.

  • Generic (brand) names. Acetaminophen (Tylenol, others).
  • How it works. Acetaminophen is thought to block the production of prostaglandins in the central nervous system. Prostaglandins are hormonelike substances that are involved in pain and inflammation. Unlike NSAIDs, acetaminophen doesn’t target inflammation at the site of injury — only pain.
  • Benefits and risks. Acetaminophen is generally considered safer than other pain relievers. It doesn’t cause side effects such as stomach pain and bleeding. However, taking more than the recommended dose or taking acetaminophen with alcohol increases the risk of kidney damage and liver failure over time.
  • Bottom line. Acetaminophen is generally a safe option to try first for many types of pain, including chronic pain. Ask your health care provider for guidance about other medications to avoid while taking acetaminophen. Acetaminophen is not as effective as NSAIDs for the treatment of knee and hip pain related to osteoarthritis.

What are other pharmacological non opioid options to manage chronic pain?

Table 1. PICOTS: Inclusion and exclusion criteria –

PICOTS Include Exclude
Populations and Conditions
  • For all KQs: Adults (age ≥18 years) with various types of chronic pain (defined as pain lasting >3 months), including patients with acute exacerbations of chronic pain, pregnant/breastfeeding women, and patients with opioid use disorder
  • For KQs 1b, 2b Specific chronic pain populations:
    • Neuropathic
    • Musculoskeletal (low back pain, neck pain and osteoarthritis)
    • Fibromyalgia
    • Sickle cell disease
    • Inflammatory arthritis (e.g., rheumatoid arthritis)
    • Chronic headache a
  • Pain at the end of life
  • Acute pain
  • Pain due to active malignancy
  • Pain due to sickle cell crisis
  • Episodic migraine
  • Undefined mixed pain conditions
Interventions Nonopioid pharmacologic treatments given specifically for chronic pain including:

  • Oral pharmacologic agents:
    • Acetaminophen
    • NSAIDs (e.g., celecoxib, diclofenac, ibuprofen, naproxen)
    • Antidepressant medications specifically used to treat chronic pain; SNRIs (i.e. desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine) and TCAs (e.g., amitriptyline, desipramine, doxepin, imipramine, nortriptyline)
    • Anticonvulsant medications specifically used to treat chronic pain: carbamazepine, gabapentin, oxcarbazepine, pregabalin
    • Muscle relaxants (including benzodiazepines) commonly used to treat chronic pain (e.g., cyclobenzaprine, tizanidine, diazepam)
    • Other: Memantine
  • Topical pharmacologic agents

    Diclofenac, capsaicin, and lidocaine

  • Medical cannabis (inhaled, oral, and topical)
  • Phytocannabinoids (plant-derived): THC and CBD
  • Synthetic cannabinoids (FDA-approved): Dronabinol (THC), Nabilone (similar to THC)
  • Injectable preparations, including biologic drugs, corticosteroids, etc.
  • Other antidepressants not typically used to treat chronic pain, including SSRIs and MAOIs
  • Other antiepileptics not typically used to treat chronic pain, including topiramate, lamotrigine, levetiracetam, phenytoin, valproic acid, zonisamide, tiagabine
  • Drugs used for migraine prophylaxis (e.g., verapamil, beta-blockers) or treating acute migraine (e.g., triptans)
  • Salicylates (topical and oral)
  • Topical menthol preparations
  • Disease-modifying drugs for rheumatoid arthritis (DMARDs, e.g. methotrexate, gold)
  • For KQ 1a/b and 2a/b: Placebo
  • For KQ 1c and 2a/b: Another included nonopioid pharmacologic agent, dose, or treatment duration
  • Nonpharmacologic treatment (comparison to nonopioids included in review of nonpharmacologic treatments)
  • Opioid treatment
  • Pain (intensity, severity, bothersomeness), function (physical disability, activity limitations, activity interference, work function), and quality of life.
    • Only validated outcome measures of pain, overall function or disability, and quality of life
    • Secondary outcomes will include depression, anxiety, sleep, and global assessments using validated scales
  • All drug classes: Withdrawals due to adverse events, serious adverse events, overdose (intentional and unintentional), misuse, and dependence.
  • Key specific adverse events, according to drug class, such as gastrointestinal and cardiovascular events, kidney and liver-related harms with NSAIDs, weight gain, dry mouth/blurred vision, cognitive effects, sedation for gabapentin/pregabalin

Intermediate outcomes (e.g., pharmacokinetics/pharmacodynamics, drug-drug interactions, dose conversions)


Short-term treatment duration (3 to 6 months), intermediate-term treatment duration (6 to 12 months), and long-term treatment duration (≥12 months)

Studies or outcomes reported with <3 month duration of treatmentb


Outpatient settings (e.g., primary care, pain clinics, other specialty clinics, emergency rooms, urgent care clinics)

Addiction treatment settings, inpatient settings

Study Design
  • Randomized controlled trials
  • High-quality, recent systematic reviews, selecting a limited number that best match the scope of this review b
  • Observational studies
  • Systematic reviews may be excluded based on currency (e.g., if there is a substantial new body of evidence not included) or relevance (e.g., do not report outcomes or time frames of interest).

CBD = cannabidiol; FDA = Food and Drug Administration; KQ = Key Question; MAOI = monoamine oxidase inhibitor; NSAID = nonsteroidal anti-inflammatory drug; SNRI = serotonin and norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; THC = tetrahydrocannabinol a Chronic headache defined as (International Classification of Headache Disorders, 3rd edition definition 12 ): Primary headaches attributed to the headache condition itself, not caused by another disease or medical condition.

Chronic headache is defined as 15 or more days each month for at least 12 weeks or history of headache more than 180 days a year. b The Evidence-based Practice Center will assess available literature to ensure that adequate evidence exists from studies of ≥3 months’ treatment duration, and consider adding shorter-duration studies where evidence is inadequate.

If high-quality systematic reviews are available covering the scope of the review for shorter duration studies, we will summarize these. Below are additional details on the scope of this project: Study Design: For all Key Questions, we will include and focus on randomized controlled trials (RCTs) with at least 3 months duration to maintain a manageable scope for this review, recognizing that by definition, chronic pain requires treatments that are effective in the long term, and short-term benefits may not persist.

This duration threshold is similar to the duration used in the prior AHRQ systematic review on nonpharmacologic interventions for chronic pain, 13 which included studies with greater than one month of followup after the end of treatment, with most studies involving 6 to 8 weeks of treatment. The Evidence-based Practice Center (EPC) will evaluate the availability and quality of studies with three to six months duration to determine if an evaluation of studies with shorter durations is needed.

As noted above, if there is inadequate evidence found in this window of duration, we will consider inclusion of studies with shorter durations, using existing systematic reviews to summarize the evidence, if possible. We will evaluate the persistence of benefits or harms by evaluating the three periods identified in the Key Questions (3 to 6 months, 6 to 12 months, and ≥12 months).

  • We will use existing systematic reviews primarily to screen their included studies to insure we have identified all relevant studies for this review.
  • In the case where a systematic review is recent enough to cover the majority of the available evidence, and evaluates a cohesive group of interventions, outcomes and time frames included here, we will include the review as the primary evidence and supplement with any newer or excluded studies.

Non-English Language Studies: We will restrict to English-language articles, but will review English language abstracts of non-English language articles to identify studies that would otherwise meet inclusion criteria, in order to assess for the likelihood of language bias.

What is pharmacological vs non-pharmacological?


Pharmacological Management : management of symptoms through the use of medication. Non-Pharmacological Management : management of symptoms without the use of medication such as in this example of OA with exercise, weight loss and acupuncture.

What are the difference between pharmacologic and nonpharmacologic pain management on false and true labor pain?

Plain english summary – For most women, labour pain is the most severe pain they will ever experience. Women regularly use medications and/or natural methods for labour pain relief. We searched for published studies on women’s views and experiences of epidurals, opioid injections such as pethidine, relaxation and massage techniques.

We included 24 good quality studies, all from high and middle-income countries (HMICs). We developed review findings for each method. We then examined differences and similarities in women’s experiences of different pain relief methods. ‘Desires for pain relief’ highlights the different reasons women give for choosing medications or other approaches.

‘Impact on pain’ describes how the techniques either were or were not effective in reducing labour pain. ‘ Influence and experience of support’ highlights women’s experiences of positive or negative support from professionals and/or birth companions. ‘ Influence on focus and capabilities’ describes that while all pain relief methods could help women feel in control, some found the natural methods to be less effective than anticipated, and others disliked complications they experienced after using medication.

What does pharmacologic mean in medical terms?

(FAR-muh-KAH-loh-jee) The study of the origin, chemistry, and uses of drugs and their effects on the body.

What are the benefits of pharmacological pain management?

These potential benefits include: better control of pain, which may improve how you feel and function physically; an increased ability to function in personal and professional relationships, as well as an improved sense of overall well-being; and or a decrease in the intensity of pain.

What is the difference between pharmacologic and therapeutic?

The pharmacological effect is the prevention of replication of the bacteria, the therapeutic effect is to cure the infection.

What is the pharmacologic of a drug?

Pharmacology is the scientific study of the effects of drugs and chemicals on living organisms where a drug can be broadly defined as any chemical substance, natural or synthetic, which affects a biological system. Pharmacology may involve how organisms handle drugs, identification and validation of new targets for drug action, and the design and development of new drugs to prevent, treat and cure disease.

Pharmacology research is also a critical component in the development of modern ‘personalized medicine’. There are many sub-specialties within the general discipline of pharmacology. Pharmacodynamics is the study of the effects of drugs on biological systems and specifically addresses the chemical properties and physiological and behavioral effects of drugs arising from their interaction with molecular targets such as receptor proteins or enzyme systems.

In contrast, pharmacokinetics is the study of what biological systems do to the drug and encompasses investigations of drug absorption, distribution, biotransformation and excretion, essential information for the design of drug treatment schedules in different patient populations and experimental animals, and for the prediction of drug-drug interactions that may enhance or compromise the effectiveness and safety of t therapeutic agents.

Pharmacologists require sound basic knowledge of physiology, biochemistry, cell biology and molecular biology upon which to build their specialized knowledge and experimental approaches for the investigation of novel aspects of drug action. Such studies may occur at various levels, including molecular interactions, cellular and subcellular signal transduction processes, tissue and organ regulation, as well as integrated physiological or behavioral responses in intact organisms.

The knowledge acquired facilitates the development of new drugs and contributes to rational therapeutics that involves the safe and effective use of drugs for therapeutic benefit. Also, this interdisciplinary knowledge offers pharmacologists a unique perspective on a wide range of biomedical issues and enhances employment opportunities in many areas of scientific investigation.