Pain - Adjuvants

9 important questions on Pain - Adjuvants

What type of pain should adjuvants be used in?

Any type, but especially for neuropathic pain

Why types of drugs are used as adjuvants for neuropathic pain?

Antiseizure meds (ASMs), SNRIs and TCAs

What types of drugs are used as adjuvants for musculoskeletal pain/spasms?

Antispasmodics (muscle relaxants)
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List the antispasmodics with analgesic effects used for musculoskeletal pain/spasms

Baclofen (Lioresal)
Cyclobenzaprine (Amrix, Fexmid)
Tizanidine (Zanaflex) 

Side effects of all muscle relaxants

Excessive sedation, dizziness, confusion, asthenia (muscle weakness)

List the antispasmodics that work by sedation

Carisprodol (Soma)
Metaxalone
Methocarbamol (Robaxin)  

Who will have increased carisoprodol concentrations?

Poor CYP2C19 metabolizers

Which muscle relaxants are rarely used?

Dantrolene (Dantrium)- used for malignant hyperthermia
Chlorzoxane (Lorzone)
Orphenadrine

What else is lidocaine approved for?

PHN (shingles) pain

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