The Expanding Role of the COX Inhibitor/Opioid Receptor Agonist Combination in the Management of Pain
- PDF / 874,394 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 16 Downloads / 176 Views
REVIEW ARTICLE
The Expanding Role of the COX Inhibitor/Opioid Receptor Agonist Combination in the Management of Pain Giustino Varrassi1,2 · Cheng Teng Yeam3 · Martina Rekatsina4 · Joseph V. Pergolizzi5 · Panagiotis Zis6 · Antonella Paladini7
© The Author(s) 2020
Abstract Pain management in both outpatient and inpatient settings demands a multidisciplinary approach entailing medical, physical and psychological therapies. Among these, multimodal analgesic regimens stand out as a promising treatment options. Cyclooxygenase (COX) inhibitor/opioid receptor agonist combinations hold great potential as effective pillars in the multimodal pain management by providing adequate analgesia with fewer safety risks due to COX inhibitors’ opioid-sparing effect. Thus, these combinations, either freely or in fixed-dose formulation, offer a feasible option for the prescribing clinicians who seek to maximise therapeutic effect while simultaneously minimise adverse effects. The selection of the appropriate nonsteroidal anti-inflammatory drug (NSAID) and opioid agent at optimal doses is essential. It should be tailored to the patients’ analgesic necessities, and his/her gastrointestinal and cardiovascular risk, and potential concurrent aspirin use. Moreover, it should allow for addiction risk and the potential opioid-induced bowel dysfunction and constipation. To ensure an optimal match between the characteristics of the patient and the properties of the chosen medication, and to guide adequate and welltolerated treatment decisions, it is of paramount importance to expand clinicians’ knowledge of the currently available COX inhibitor/opioid receptor agonist combinations. This invited narrative review deals with the literature evidence covering the components of multimodal opioid-sparing analgesic regimens. Also, it provides insights into the clinically relevant choice criteria to ensure a patient-tailored analgesia.
1 Introduction The burden of pain is heavy and pervasive worldwide, with an estimated 20% of adults suffering from pain and 10% receiving a diagnosis of pain every year [1]. Importantly, the Global Burden of Disease Study has indicated pain and pain-related diseases as a primary cause of disability * Giustino Varrassi [email protected] 1
Paolo Procacci Foundation (PPF), Via Tacito 7, 00193 Rome, Italy
2
World Institute of Pain, Winston‑Salem, USA
3
Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
4
Moorfields Eye Hospital, London, UK
5
NEMA Research Group, Naples, FL, USA
6
Medical School, University of Cyprus, Nicosia, Cyprus
7
Department MESVA, University of L’Aquila, 67100 L’Aquila, Italy
and burden worldwide [2]. A recent European pain study recorded higher rates of pain in women and in people with lower economic status, thus, unveiling the so-called “gender- and income-related pain gap” [3]. Among the European countries, Italy ranked third with a chronic pain prevalence of 27–28% and a high proportion of untreated people (33% for both acute and chronic pain) [4, 5]. Comm
Data Loading...
