Pain Medicine

Primer

Pain Medicine is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain.

Mechanisms of Pain

Noradrenaline reuptake inhibition enhances analgesic effects, mainly through α2-adrenergic receptors in the dorsal horn of the spinal cord.[1] This is one of the main reasons for the efficacy of TCAs and SNRIs (e.g. - duloxetine) over SSRIs for neuropathic pain.[2]

Approach to Pain

Step-wise Treatment

If pain is identified, a stepwise approach to treating pain is recommended, starting with:

  1. Acetaminophen
  2. Extended release morphine
  3. Buprenorphine transdermal patch
  4. Pregabalin[3]

Resources

Providers
Articles

References

1) Obata H. (2017). Analgesic Mechanisms of Antidepressants for Neuropathic Pain. International journal of molecular sciences, 18(11), 2483.
2) Lunn, M. P., Hughes, R. A., & Wiffen, P. J. (2014). Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. The Cochrane database of systematic reviews, (1), CD007115.
3) Husebo, Bettina S., Clive Ballard, Jiska Cohen-Mansfield, Reinhard Seifert, and Dag Aarsland. "The response of agitated behavior to pain management in persons with dementia." The American Journal of Geriatric Psychiatry 22, no. 7 (2014): 708-717.