Multimodal analgesia

Chapter 11 - Multimodal analgesia (sites of analgesic activity)... 

As used for multimodal analgesia controlled-release oral morphine is prescribed to control the basal pain, and needs to be supplemented by immediate-release oral morphine for breakthrough pain. 

In most circumstances and particularly with multimodal analgesia, patients may benefit from doses of EREM lower than those in the label. Lower dosing may reduce opioid-related side effects. 

Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009 [Epub ahead of print]. 

As used for multimodal analgesia study has shown that ibuprofen can be used as an adjunct for narcotics in managing cancer pain. 

Easy to use and administer Over-the-counter formulations available Little risk of side effects with a low-dose nonchronic dosing schedule Opioid-sparing when employed as multimodal analgesia... 

As an NSAID, diclofenac is easy to use, and has been shown to be efficacious in arthritic syndromes, as well as for acute treatment of migraines, and small procedures. A major advantage of diclofenac, as with other NSAIDs, is its use in multimodal analgesia. In patients who are post-operative or with certain chronic pain syndromes, diclofenac can be used to provide additive analgesia and an opioid-sparing effect. Diclofenac has decreased side effects when compared to opioids in terms of nausea, respiratory depression, sedation, and constipation. 

As used for multimodal analgesia bupivacaine regional anesthesia/analgesia plays a vital role as the center of a multimodal pain management protocoL... 

As used for multimodal analgesia often a useful analgesic adjunct to other therapeutic interventions may also improve mood and sleep. 

As used for multimodal analgesia cyclobenz-aprine (Flexeril), carisoprodol (Soma), oral steroids, opioids, and NSAIDs can all be used in combination therapy with caution, based on the severity and onset of symptoms. 

Methocarbamol can be used alongside rest and physical therapy as well as combined with other medications as part of multimodal analgesia in the treatment of musculoskeletal pain. Since it may possess a general CNS depressant effect, caution is advised when used in combination with other CNS depressants. 

As used for multimodal analgesia HI antihistamines have been reported to decrease morphine and acetaminophen requirement for post-operative pain. When HI antihistamines are given in combination... 

Sensory systems - Eye Nefopam is a non-opioid analgesic whose action is spinal and supraspinal, including inhibition of dopamine, noradrenaline, and serotonin reuptake. A dose of 20mg has an analgesic action comparable with morphine 6 mg. Acute glaucoma angle closure is a rare complication of anaesthesia and multimodal analgesia. However, a case of unilateral permanent loss of vision after nefopam administration was reported. 

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