Standard Systemic Analgesic Agents

Chapter 9 addresses drugs used for pain management. These drugs are categorized as standard systemic analgesic agents, including nonopioid and opioid analgesics, and other, neuromodulating, agents that are addressed in subsequent chapters. There is significant variability in individual response to standard systemic analgesics, and choice of therapy should foremost include patient-specific considerations balancing efficacy with tolerability. Acetaminophen is widely recommended for various acute and chronic pain syndromes and is generally considered safe when taken within therapeutic doses. Nonsteroidal anti-inflammatory drugs (NSAIDs) are versatile analgesics and are commonly utilized for general mild to moderate pain. NSAIDs are the most widely used analgesics today. Opioids are effective for severe pain, such as pain from acute trauma, postsurgical pain, and cancer pain, but require intense monitoring for side effects. All opioids cause sedation, constipation, nausea, and somnolence and can cause respiratory depression, physical dependence, and death. Opioids are available in both short-acting and extended-release or long-acting formulations. Like NSAIDs, opioids should be used at the lowest dose for the shortest duration of time when possible.