The Expanding Role of the COX Inhibitor/Opioid Receptor Agonist Combination in the Management of Pain.
Guistino VarassiCheng Teng YeamMartina RekatsinaJoseph V PergolizziPanagiotis ZisAntonella PaladiniPublished in: Drugs (2021)
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. Cyclo-oxygenase (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 non-steroidal 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 well-tolerated 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.
Keyphrases
- pain management
- chronic pain
- anti inflammatory
- healthcare
- palliative care
- neuropathic pain
- mental health
- systematic review
- case report
- primary care
- low dose
- ejection fraction
- emergency department
- newly diagnosed
- physical activity
- drug delivery
- coronary artery disease
- spinal cord injury
- prognostic factors
- atrial fibrillation
- high glucose
- patient reported outcomes
- adverse drug
- stress induced
- electronic health record