Pain Archetypes and Useful Adjuvant Analgesics
Somatic/Musculoskeletal ...

Pain Archetypes and Useful Adjuvant Analgesics

Somatic/Musculoskeletal – easily localized, sharp, aching, gnawing

 • Bony pain – high dose NSAIDs or steroids*. Consider palliative XRT or surgery.

 • Muscle spasm – topical lidocaine, capsaicin, methy salicylate-menthol ointment (Bengay); muscle relaxants such as benzos, baclofen, tizanidine (watch for sedation & delirium)

Visceral – deep tisues and internal organs, vague, referred or difficult to localize

 • Visceral distension (e.g., hepatic capsular stretch from liver mets, malignant bowel obstruction) – depends on etiology but steroids* can be helpful

Inflammatory – associated with other signs of inflammation (swelling, erythema, warmth)

 • NSAIDs, steroids*

Neuropathic – burning, stinging, allodynia (perceiving innocuous stimuli as painful), hyperalgesia

 • Topical lidocaine and diclofenac gel (NB: often short-term benefit, often not covered by insurance as outpatient)

 • Pregabalin, gabapentin, clonidine, SNRIs (duloxetine, venlafaxine), TCAs (amitriptyline, nortriptyline, desipramine)

*Caution using steroids in cancer patients, may interfere with treatment (e.g, immunotherapy)

#Adjuvant #Analgesics #Pain #Archetypes #Indications #management 
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