Overview and new directions in the pharmacotherapy of pain


Chair: Patrice Forget, United Kingdom
Speaker: Bart Morlion, Belgium
Pain is a complex biopsychosocial phenomenon and involves complex interactions between biological, psychological, social, and cultural factors. Therefore, multimodal pain management mostly refers to treatment paradigm that includes not only medical technical interventions but also all necessary, non-drug interventions, psychological support, physical exercise and rehabilitation. Pharmacotherapy, including non-opioid, opioid analgesics and atypical analgesics forms one of the pillars of this multimodal approach. From the perspective of pharmacotherapy, multimodal analgesia (MMA) refers to the simultaneous use of multiple analgesic medications that work in a synergistic manner, providing pain control while mitigating the adverse effects of each individual drug due to lower dosages. A more recent goal of MMA is the opioid sparing strategy. Combining medicines with different pharmacodynamic actions will interfere with the basic processes of the nociceptive system: transduction, transmission, modulation, perception and descending inhibition. MMA involves apart from opioids a combination of paracetamol, NSAIDs, COX-2 inhibitors, NMDA antagonists, local anesthetics, dexamethasone and neuromodulators such as pregabalin and gabapentin. In general, pharmacotherapy shows good efficacy in acute pain. However, in chronic pain only low to moderate efficacy is reported. Pain specialists often prescribe drugs off-label in individual therapeutic trials. Despite the enormous progress in basis pain research and the identification of many new targets, only a disappointing translation from rodent research to the clinic was achieved over the last years. Nevertheless, some novelties will reach the market within the next two years, including the introduction of biological medicines in pain medicine.

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