Multimodal Analgesia: Polypharmacy in Pain Relief or Rational Use of Non-Steroidal Anti-Inflammatory Drugs to Prevent Pain Chronicity

Fedir Hladkykh

Abstract

Pain is the psychophysiological reaction of an entire organism to a damaging factor. According to the literature, 30.0–75.0 % of patients suffer from severe pain in the postoperative period. The greatest risk of chronicity is severe pain after highly traumatic operations and in cases where there is a neuropathic component of acute pain.
The purpose of the work is to evaluate the feasibility of using non-steroidal anti-inflammatory drugs with multimodal analgesia to prevent pain chronicity. Despite the detailed mechanisms of pain formation, to date, there is no ideal analgesic or method for the treatment of acute postoperative pain of high intensity. The most significant complication in the use of opioid analgesics is iatrogenic hyperalgesia, which leads to an increase in the intensity of acute postoperative pain, which is also a risk factor for the formation of chronic postoperative pain. It is possible to get closer to solving the problem of adequate postoperative analgesia only by implementing the concept of multimodal analgesia in the clinic, which involves the simultaneous use of two or more analgesics that have different mechanisms of action and have a synergistic effect. The use of the non-steroidal anti-inflammatory drugs as part of multimodal analgesia reduces the risk of their long-term use, due to effective analgesia and prevention of chronic pain syndrome.




Keywords


multimodal analgesia; non-steroidal anti-inflammatory drugs; pain; polypharmacy; adjuvant analgesics



References


Nevzorova, D. V., & Abuzarova, G. R. (2017). Klinicheskie rekomendatsii: khronicheskij bolevoj sindrom u vzroslykh patsientov, nuzhdayushchikhsya v palliativnoj meditsinskoj pomoshchi [Clinical recommendations: chronic pain syndrome in adult patients requiring palliative care]. Therapy, 2(12), 69–75 (in Russian)
[Невзорова, Д. В., & Абузарова, Г. Р. (2017). Клинические рекомендации: хронический болевой синдром у взрослых пациентов, нуждающихся в паллиативной медицинской помощи. Терапия, 2(12), 69–75].

Ministry of Health of the Russian Federation. (2016). Khronicheskij bolevoj sindrom u vzroslykh patsientov, nuzhdayushchikhsya v palliativnoj meditsinskoj pomoshchi. Klinicheskie rekomendatsii [Chronic pain syndrome in adult patients in need of palliative care. Clinical guidelines]. Retrieved from https://bit.ly/2DitOVY (in Russian)
[Министерство здравоохранения Российской Федерации. (2016). Хронический болевой синдром у взрослых пациентов, нуждающихся в паллиативной медицинской помощи. Клинические рекомендации. URL: https://bit.ly/2DitOVY].

Zhivolupov, S. A., Litvinenko, I. V., Samartsev, I. N., Rashidov, N. A., Kravchuk, A. Y., & Barinov, A. N. (2020). Drug therapy for chronic musculoskeletal pain syndromes: the concept of adjuvant analgesics and the prospect of its implementation. Neurology, Neuropsychiatry, Psychosomatics, 12(1), 105–111. doi: 10.14412/2074-2711-2020-1-105-111

Ushkalova, E. A., Zyryanov, S. K., & Zatolochina, K. E. (2020). The fixed combination of diclofenac and orphenadrine in the treatment of acute pain syndromes. Neurology, Neuropsychiatry, Psychosomatics, 12(1), 100–104. doi: 10.14412/2074-2711-2020-100-104

Vandanov, B. K., Shizmetov, A. N., & Lebedev, N. N. (2017). Ketorolak v skheme mul'timodal'nogo obezbolivaniya [Ketorolac in the multimodal anesthesia regimen]. Ambulatory Surgery, 1–2, 65–66 (in Russian)
[Ванданов, Б. К., Шизметов, А. Н., Лебедев, Н. Н. (2017). Кеторолак в схеме мультимодального обезболивания. Амбулаторная Хирургия, 1–2, 65–66].

Davydov, O. S. (2016). The peripheral and central mechanisms of transition of acute to chronic pain and the possible role of cyclooxygenase-2 inhibition in the prevention of pain syndrome chronization. Neurology, Neuropsychiatry, Psychosomatics, 8(2), 10–16. doi: 10.14412/2074-2711-2016-2-10-16

Latremoliere, A., & Woolf, C. J. (2009). Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity. The Journal of Pain, 10(9), 895–926. doi: 10.1016/j.jpain.2009.06.012

Volchkov, V. A., Kovalev, S. V., & Kubynin, A. N. (2018). Сontemporary aspects of postoperative analgesia (review). Vestnik of Saint Petersburg University. Medicine, 13(3), 245–270. doi: 10.21638/11701/spbu11.2018.303

Fletcher, D., Stamer, U. M., Pogatzki-Zahn, E., Zaslansky, R., Tanase, N. V., Perruchoud, C., … Meissner, W. (2015). Chronic postsurgical pain in Europe. European Journal of Anaesthesiology, 32(10), 725–734. doi: 10.1097/eja.0000000000000319

Sharipova, V. Kh. (2015). Kliniko-patogeneticheskoe obosnovanie adekvatnosti mul'timodal'noj anal'gezii v perioperatsionnom periode pri dlitel'nykh travmatichnykh operativnykh vmeshatel'stvakh [Clinical-pathogenetic reasoningof multimodal analgesia adequacy in peryoperative period in long-termed traumatic abdominal operative interventions]. The Bulletin of Contemporary Clinical Medicine, 8(4), 42–49 (in Russian)
[Шарипова, В. Х. (2015). Клинико-патогенетическое обоснование адекватности мультимодальной анальгезии в периоперационном периоде при длительных травматичных оперативных вмешательствах. Вестник современной клинической медицины, 8(4), 42–49].

Danilov, A. B. (2016). Upravlenie bol'yu. Biopsikhosotsial'nyi podkhod [Pain management. Biopsychosocial approach]. Moscow: AMM-press (in Russian)
[Данилов, А. Б. (2016). Управление болью. Биопсихосоциальный подход. Москва: АММ-пресс].

Halikova, E. Yu. (2014). Nejropaticheskaya bol' kak komponent ostroj i khronicheskoj postoperatsionnoj i posttravmaticheskoj boli: ot diagnostiki k ratsional'noj farmakoterapii [Neuropathic pain as a component of acute and chronic postoperative and post-traumatic pain: from diagnosis to rational pharmacotherapy]. Russian Medical Journal, 38–42 (in Russian)
[Халикова, Е. Ю. (2014). Нейропатическая боль как компонент острой и хронической постоперационной и посттравматической боли: от диагностики к рациональной фармакотерапии. Российский медицинский журнал, 38–42].

Kampe, S., Geismann, B., Weinreich, G., Stamatis, G., Ebmeyer, U., & Gerbershagen, H. J. (2016). The Influence of Type of Anesthesia, Perioperative Pain, and Preoperative Health Status on Chronic Pain Six Months After Thoracotomy – A Prospective Cohort Study. Pain Medicine, pnw230. doi: 10.1093/pm/pnw230

Correll, D. (2017). Chronic postoperative pain: recent findings in understanding and management. F1000Research, 6, 1054. doi: 10.12688/f1000research.11101.1

Avakov, V. E., Sayipov, R. M., Isomov, T. M., & Bozorov, G. M. (2016). Paratsetamol (influgan) v posleoperatsionnoi analgezii [Paracetamol (Influgan) in postoperative analgesia]. Travma, 17(1), 28–32 (in Russian)
[Аваков, В. Е., Сайипов, Р. М., Исомов, Т. М., & Бозоров, Г. М. (2016). Парацетамол (инфлуган) в послеоперационной аналгезии. Травма, 17(1), 28–32].

Medvedeva, L. A., Zagorul’ko, O. I., & Belov, Yu. V. (2017). Khronicheskaya posleoperatsionnaya bol': sovremennoe sostoyanie problemy i etapy profilaktiki [Chronic post-operative pain: current state of evidence and prevention]. Anesteziologiya i reanimatologiya, 62(4), 305–309 (in Russian)
[Медведева, Л. А., Загорулько, О. И., & Белов, Ю. В. (2017). Хроническая послеоперационная боль: современное состояние проблемы и этапы профилактики. Анестезиология и реаниматология, 62(4), 305–309].

Kalashnik, L. (2015). Sravnitel'naya kharakteristika gabapentina i pregabalina [Comparative characteristics of gabapentin and pregabalin]. Neuro News, 2(76), 12–14 (in Russian)
[Калашник, Л. (2016). Сравнительная характеристика габапентина и прегабалина. НейроNews. 2(76), 12–14].

Kukushkin, M. L., Podchufarova, E. V., & Yakhno, N. N. (2011). Fiziologiya i patofiziologiya boli [Physiology and pathophysiology of pain]. Moscow: Izdatel'stvo RAMN (in Russian)
[Кукушкин, М. Л., Подчуфарова, Е. В., & Яхно, Н. Н. (2011). Физиология и патофизиология боли. Москва: Издательство РАМН].

Dmytriiev, D., Prudius, P., Zaletskaya, O., Lisak, Y., Rudnitsky, Y., & Korenchuk, N. (2019). Neuropathic pain: mechanisms of development, principles of diagnostics and treatment. Pain Medicine, 4(2), 4–32. doi: 10.31636/pmjua.v4i2.1

De Leo, J. A., Tawfik, V. L., & LaCroix-Fralish, M. L. (2006). The tetrapartite synapse: Path to CNS sensitization and chronic pain. Pain, 122(1), 17–21. doi: 10.1016/j.pain.2006.02.034

Ovsyannikov, V. G., Boychenko, A. E., Alekseev, V. V., Kapliev, A. V., Alekseeva, N. S., Kotieva, I. M., & SHumarin, A. E. (2014). Antinotsitseptivnaia sistema [Antinociceptive system]. Meditsinskii vestnik IUga Rossii, 3, 46–54 (in Russian)
[Овсянников, В. Г., Бойченко, А. Е., Алексеев, В. В., Каплиев, А. В., Алексеева, Н. С., Котиева, И. М., & Шумарин, А. Е. (2014). Антиноцицептивная система. Медицинский вестник Юга России, 3, 46–54].

Verlan, N. V. (2016). Vozmozhnosti optimizatsii posleoperatsionnoj anal'gezii [Possibilities for optimizing postoperative analgesia]. Ambulatory Surgery, 1–2, 61–62 (in Russian)
[Верлан, Н. В. (2016). Возможности оптимизации послеоперационной анальгезии. Амбулаторная хирургия, 1–2, 61–62].

Ovechkin, A. M., Sokologorskiy, S. V., & Politov, M. E. (2019). Opioid-Free Anaesthesia and Analgesia – Tribute to Fashion or the Imperative of Time? Novosti Khirurgii, 27(6), 700–715. doi: 10.18484/2305-0047.2019.6.700

Ahmadi, K., Masoumi, B., Mehrpour, O., Hashemian, A., Omraninava, A., Kakhki, A., & Sharifi, M. (2014). Effectiveness of local anesthesia with lidocaine in chronic opium abusers. Journal of Emergencies, Trauma, and Shock, 7(4), 301. doi: 10.4103/0974-2700.142765

Klyuchnikov, S. O. (2014). Polipragmaziya: puti resheniya problemy [Polypharmacy: response]. Children Infections, 4, 36–41 (in Russian)
[Ключников, С. О. (2014). Полипрагмазия: пути решения проблемы. Детские инфекции, 4, 36–41].

Tareev, E. (2014). Opasnaya nagruzka: polipragmaziya [Dangerous load: polypharmacy]. Pharmacist Practic, 2, 2–29 (in Russian)
[Тареев, Е. (2014). Опасная нагрузка: полипрагмазия. Фармацевт Практик, 2, 2–29].

Kehlet, H., & Dahl, J. B. (1993). The Value of “Multimodal” or “Balanced Analgesia” in Postoperative Pain Treatment. Anesthesia & Analgesia, 77(5), 1048–1056. doi: 10.1213/00000539-199311000-00030

Amirdzhanova, V. N. (2017). Nonsteroidal anti-inflammatory drugs: a difficult choice of anesthesia during joint surgery. Rheumatology Science and Practice, 55(5), 555–559. doi: 10.14412/1995-4484-2017-555-559

Sokologorsky, S. V. (2015). Deksketoprofen – instrument perioperatsionnogo obezbolivaniya [Dexketoprophenum as a tool for perioperativeanalgesia]. Gynecology, 16(5), 16–22 (in Russian)
[Сокологорский, С. В. (2015). Декскетопрофен – инструмент периоперационного обезболивания. Гинекология, 16(5), 16–22].

N. d. (2019). Svyaz mezhdu selektivnostyu NPVP i ih effektivnostyu. Perspektivyi dlitelnogo lecheniya [The relationship between the selectivity of NSAIDs and their effectiveness. Prospects for Long-Term Treatment]. Ukrainian Medical Chronicle, 2(130/1), 40–41 (in Russian)
[N. d. (2019). Связь между селективностью НПВП и их эффективностью. Перспективы длительного лечения. Укрaїнський медичний часопис, 2(130/1), 40–41].

Hladkykh, F. V. (2017). Preventive and therapeutic strategies of pharmaco-correction gastropathy induced by nonsteroidal anti-inflammatory drugs. Reviews on Clinical Pharmacology and Drug Therapy, 15(4), 14–23. doi: 10.17816/rcf15414-23

Hladkykh, F. V., Stepaniuk, N. H. (2014). Suchasni shliakhy poslablennia ultserohennosti nesteroidnykh protyzapalnykh zasobiv: dosiahnennia, nevyrisheni pytannia ta shliakhy optymizatsii [New approaches to reduce ulcerogenity of nonsteroidal anti-infl ammatory drugs: achievements, unsolved issues and ways to optimize]. Zaporozhskyi medytsynskyi zhurnal, 2, 82–86 (in Ukrainian)
[Гладких, Ф. В., Степанюк, Н. Г. (2014). Сучасні шляхи послаблення ульцерогенності нестероїдних протизапальних засобів: досягнення, невирішені питання та шляхи оптимізації. Запорожский медицинский журнал, 2, 82–86].

Gelir, I. K. (2016). Preventive effect of dexketoprofen on postoperative pain. Ağrı - The Journal of The Turkish Society of Algology. doi: 10.5505/agri.2015.08379

Anıl, A., Kaya, F. N., Yavaşcaoğlu, B., Mercanoğlu Efe, E., Türker, G., & Demirci, A. (2016). Comparison of postoperative analgesic efficacy of intraoperative single-dose intravenous administration of dexketoprofen trometamol and diclofenac sodium in laparoscopic cholecystectomy. Journal of Clinical Anesthesia, 32, 127–133. doi: 10.1016/j.jclinane.2016.02.020

Schug, S., Parsons, B., Li, C., & Xia, F. (2017). The safety profile of parecoxib for the treatment of postoperative pain: a pooled analysis of 28 randomized, double-blind, placebo-controlled clinical trials and a review of over 10 years of postauthorization data. Journal of Pain Research, 10, 2451–2459. doi: 10.2147/jpr.s136052

Dugieva, M. Z., Sviridov, S. V., Sleptsov, N. I., & Morozova, K. V. (2012). Kontroliruemaya anal'geziya v rannem posleoperatsionnom periode u patsientok ginekologicheskogo profilya [Analgeziya supervised by the patient in the early postoperative period at gynecologic patients]. Surgery News, 20(3), 94–99 (in Russian)
[Дугиева, М. З., Свиридов, С. В., Слепцов, Н. И., & Морозова, К. В. (2012). Контролируемая анальгезия в раннем послеоперационном периоде у пациенток гинекологического профиля. Новости хирургии, 20(3), 94–99].

Yucel, A. (2016). Is Lornoxicam Better Than Low-Dose Tramadol for Post-thyroidectomy Pain? Ağrı - The Journal of the Turkish Society of Algology. doi: 10.5505/agri.2016.94546

Holovanova, A., Kyrychek, L., Yermolenko, T., … Hladkykh, F. (2017). Pharmacotherapeutic Effect of Stress Protectors in the Age Aspect. Path of Science, 3(12), 5001–5013. doi: 10.22178/pos.29-6

Burchinskij, S. G. (2015). Selektivnye ingibitory obratnogo zakhvata serotonina [Selective serotonin reuptake inhibitors: choice of a neurologist]. Neuro News, 2(66), 55–60 (in Russian)
[Бурчинский, С. Г. (2015). Селективные ингибиторы обратного захвата серотонина: выбор невролога. НейроNews, 2(66), 55–60].

Maksimov, M. L. (2014). Mesto miorelaksantov v lechenii bolevogo sindroma [Place of muscle relaxants in the treatment of pain]. Russian Medical Journal, 7, 514–517 (in Russian)
[Максимов, М. Л. (2014). Место миорелаксантов в лечении болевого синдрома. Российский медицинский журнал, 7, 514–517].


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.




Copyright (c) 2020 Fedir Hladkykh

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.