Page 25 Acute Pain Management
P. 25






 Based
on
the
experience
in
chronic
neuropathic
pain
states,
it
would
seem
reasonable
to

use
tricyclic
antidepressants
and
selective
serotonin
re‐uptake
inhibitors
in
the

management
of
acute
neuropathic
pain
(S).

 To
minimise
adverse
effects,
particularly
in
elderly
people,
it
is
advisable
to
initiate

treatment
with
low
doses
(U).


Anticonvulsant
drugs

1.
 Gabapentin
is
effective
in
the
treatment
of
chronic
neuropathic
pain
(Q);
lamotrigine
is

most
likely
ineffective
(N)
(Level
I
[Cochrane
Review]).


2.
 Carbamazepine
is
effective
in
the
treatment
of
trigeminal
neuralgia
(N)
(Level
I
[Cochrane

Review]).


3.
 Pregabalin
is
effective
in
the
treatment
of
chronic
neuropathic
pain
related
to
diabetic
 SUMMARY

neuropathy
(N)
(Level
I).

4.
 Perioperative
gabapentinoids
(gabapentin/
pregabalin)
reduce
postoperative
pain
and

opioid
requirements
(U)
and
reduce
the
incidence
of
vomiting,
pruritus
and
urinary

retention,
but
increase
the
risk
of
sedation
(N)
(Level
I).


 Based
on
the
experience
in
chronic
neuropathic
pain
states,
it
would
seem
reasonable
to

use
anticonvulsants
in
the
management
of
acute
neuropathic
pain
(U).

Membrane
stabilisers

1.
 Both
lignocaine
(lidocaine)
and
mexiletine
are
effective
in
the
treatment
of
chronic

neuropathic
pain
(S);
there
is
no
difference
in
efficacy
or
adverse
effects
compared
with

carbamazepine,
amantadine,
or
morphine
(N)
(Level
I
[Cochrane
Review]).


2.
 Perioperative
intravenous
lignocaine
reduces
pain
and
opioid
requirements
following

abdominal
surgery
(S)
as
well
as
nausea,
vomiting,
duration
of
ileus
and
length
of
hospital

stay
(N)
(Level
I).



 Based
on
the
experience
in
chronic
neuropathic
pain
states,
it
would
seem
reasonable
to

use
membrane
stabilisers
in
the
management
of
acute
neuropathic
pain
(U).

 Lignocaine
(intravenous
or
subcutaneous)
may
be
a
useful
agent
to
treat
acute

neuropathic
pain
(U).


Alpha‐2
agonists

1.
 The
use
of
systemic
alpha‐2‐agonists
consistently
improves
perioperative
opioid

analgesia
but
the
frequency
and
severity
of
side
effects
may
limit
their
clinical
usefulness

(U)
(Level
II).

Salmon
calcitonin
and
bisphosphonates

1.
 Bisphosphonates
reduce
bone
pain
associated
with
metastatic
cancer
and
multiple

myeloma
(N)
(Level
I
[Cochrane
Review]).

2.
 Salmon
calcitonin
reduces
pain
and
improves
mobilisation
after
osteoporosis‐related

vertebral
fractures
(S)
(Level
I).


3.
 Salmon
calcitonin
reduces
acute
but
not
chronic
phantom
limb
pain
(N)
(Level
II).

4.
 Pamidronate
reduces
pain
associated
with
acute
osteoporotic
vertebral
fractures
(N)

(Level
II).






 Acute
pain
management:
scientific
evidence
 xxv

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