From the Guidelines
Adjunct pain medications are supplementary drugs used alongside primary pain relievers to enhance pain control through different mechanisms, and they include anticonvulsants, antidepressants, corticosteroids, and local anesthetics/topical agents. These medications are used to manage various types of pain, including neuropathic, bone, and visceral pain, and to reduce the systemic opioid requirement.
- Anticonvulsants, such as gabapentin and pregabalin, are commonly used to treat neuropathic pain, as evidenced by studies in non-cancer neuropathy syndromes 1.
- Antidepressants, including tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors, are also effective in relieving neuropathic pain, with duloxetine shown to reduce pain in patients with painful chemotherapy-induced neuropathy 1.
- Corticosteroids have anti-inflammatory effects and can be used to relieve bone pain and malignant intestinal obstruction, although limited data support their effectiveness for cancer-related pain 1.
- Local anesthetics and topical agents, such as lidocaine patches and diclofenac gel, can be used to prevent procedural pain and relieve neuropathic pain, with some studies showing their effectiveness in reducing pain in patients with postherpetic neuropathy and cancer-related pain 1. The use of adjunct pain medications, such as gabapentin starting at 300mg daily and gradually increasing to 300mg three times daily, or pregabalin starting at 75mg twice daily, can be effective in managing neuropathic pain, and topical options like lidocaine patches (5%) applied to painful areas for 12 hours daily can also provide relief. Using multiple medications with different mechanisms allows for better pain control at lower doses of each medication, potentially reducing side effects while improving overall pain management.
From the FDA Drug Label
Pregabalin is indicated for: ... Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older Gabapentin Tablets, USP are indicated for: ... Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions
Adjunct pain medications are medications used in addition to primary treatment, such as:
- Pregabalin for adjunctive therapy in the treatment of partial-onset seizures
- Gabapentin for adjunctive therapy in the treatment of partial onset seizures
- Cyclobenzaprine as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2, 3, 4
From the Research
Definition of Adjunct Pain Medications
Adjunct pain medications, also known as adjuvant analgesics, are drugs that are used to manage chronic pain in addition to primary pain treatments [ 5 ]. These medications are defined as drugs that do not contain acetaminophen and are not classified as nonsteroidal anti-inflammatory or opioid agents.
Examples of Adjunct Pain Medications
Some examples of adjunct pain medications include:
- Tricyclic antidepressants, such as amitriptyline [ 6 ]
- Antiepileptic drugs, such as gabapentin and pregabalin [ 7 ]
- Topical agents, such as lidocaine plasters [ 8 ]
- Corticosteroids, which may be used to treat cancer-related pain [ 5 ]
- Parenteral bisphosphonates and strontium, which may be used to treat pain associated with bone metastases [ 5 ]
Use of Adjunct Pain Medications
Adjunct pain medications may be used as first-line therapy for certain chronic pain syndromes, such as neuropathic pain [ 6 ]. They may also be used in combination with other medications to enhance therapeutic response and reduce side effects [ 7 ].