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Analgesic drug combinations in acute and chronic pain
Neuropathic pain
Currently available drugs for neuropathic pain have demonstrated incomplete efficacy and dose-limiting adverse effects. Combining drugs with different analgesic mechanisms may result in additivity or synergism and improve efficacy at lower doses resulting in fewer side effects. To test this hypothesis, we conducted a randomized controlled trial of a combination of the anticonvulsant, gabapentin, with the opioid, morphine, in comparison with both single agents, in painful diabetic neuropathy and postherpetic neuralgia. Results of this trial suggest that pain during combination treatment is significantly lower than with treatment of either single agent (Gilron, Bailey et. al., 2005). Furthermore, superior analgesia with this combination is achieved with lower doses of each drug and without augmenting adverse effects. Following this trial, we are now seeking to evaluate other analgesic combinations in the treatment of chronic pain.
Postoperative pain
Various non-opioid analgesics have been shown to reduce movement-evoked pain as well as opioid consumption following surgery. However, most of these drugs, administered as single agents, have limited analgesic efficacy at maximal doses. We recently completed a randomized controlled trial of a combination of the anticonvulsant, gabapentin, with the COX-2 specific NSAID, rofecoxib following abdominal hysterectomy. Results of this trial suggest that a gaba pentin-rofecoxib combination provides more consistent reduction of postoperative pain at rest, and evoked by movement, as compared to either single agent without compounding adverse effects (Gilron, Orr et. al. 2005). Other observed benefits included opioid sparing and increased peak expiratory flow suggesting accelerated pulmonary recovery. Following this trial, we are now seeking to evaluate other analgesic combinations following various surgical procedures.
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Analgesic drug combinations in acute and chronic pain
