Pain can be managed through local, regional or systemic approaches depending on the type, intensity and duration of pain. Localized pain often responds well to topical treatments applied directly to the painful area. Common topical regimens include creams, gels and patches containing nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or lidocaine/prilocaine combinations.(1) These provide pain relief locally with few systemic side effects. Onset of relief is relatively quick, within 30-60 minutes, but duration is usually only 2-8 hours depending on the formulation.(1,2)
For regional pain, options include lidocaine patches, lidocaine/tetracaine combination patches or lidocaine/prilocaine cream, which are applied to broader painful areas like low back pain. Duration of relief with these regional patches ranges from 3-12 hours.(2) Systemic pain often requires oral or other routes of administration for treatments to take effect throughout the body. Acetaminophen and NSAIDs like ibuprofen are frequently used as short-acting oral options for mild to moderate acute pain, with onset within 30 minutes and duration of 4-6 hours.(3)
For more severe acute pain or chronic, around-the-clock pain, opioid analgesics play an important role. Immediate-release opioids like oxycodone provide pain relief within 30-60 minutes with a duration of action between 4-6 hours, making them suitable for intermittent or breakthrough pain.(4) However, their shorter duration necessitates more frequent dosing. Extended-release or long-acting opioid formulations like oxycodone ER, morphine sulfate ER or fentanyl patches mitigate peaks and troughs by providing continuous pain relief over 12 hours or longer with once or twice daily dosing.(5) This dosing regimen aims to better match the natural circadian rhythms for chronic pain.
While not directly relieving pain, adjuvant medications may complement pharmacological therapies. For instance, antidepressants and anticonvulsants help manage neuropathic pain by mechanisms independent of pain sensations alone.(6) Non-pharmacological options also contribute as adjunctive or stand-alone treatments. Cognitive-behavioral therapy aims to shift psychological perceptions of pain, reduce stress responses and encourage coping strategies.(7)
In conclusion, an optimal regimen considers acute versus chronic status, time of day, route of administration, onset, duration and side effect profiles to provide the most effective around-the-clock pain management with minimum disruptions to quality of life. Combining pharmacological and non-pharmacological modalities usually results in the best outcomes for both acute and chronic pain conditions.
- Sinatra R. Local Anesthetic and Combination Products. J Pain Symptom Manage. 2019 Dec;58(6):e28-e30.
- Mehta N, Dasarathy S. Topical Analgesics in Chronic Pain. Med Clin North Am. 2019 May;103(3):447-461.
- Malhotra R, Tomar R, Dhawan A. Over-the-counter analgesics in pain management. J Postgrad Med. 2018 Apr-Jun;64(2):88-93.
- Brogly SB, Saab CY. Acute Pain Management in Opioid-Tolerant Patients: A Narrative Review. Pain Ther. 2019 Dec;8(2):249-264.
- Smith HS, Darling K. Extended-release opioid analgesics: formulation considerations for prolonged pain relief. Am J Ther. 2011 Jul-Aug;18(4):296-306.
- Tendais I, Snell L, Fernandes L. The pharmacological management of neuropathic pain: an update on drugs approved or under investigation. Expert Opin Pharmacother. 2018 Jul;19(10):1103-1110.
- Ahles TA, Garner G. Psychological Aspects of Pain Management. Med Clin North Am. 2019 May;103(3):493-505.
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