Redefining the role of analgesic adjuvants in pain management: A narrative review

Abstract

Conventional analgesics have traditionally been the mainstay of pain management, but unsatisfactory pain relief and troubling side effects have led to continuing search for more efficacious and safer remedies. Adjuvant analgesics are drugs with beneficial analgesic effects despite not having been developed as analgesics. Adjuvants facilitate better pain control with a reduction in analgesic consumption, as well as the concomitant side effects. The opioid epidemic, deaths from opioid overdose, and several other complications of opioid-based analgesia have led to increasing interrogation of its use in both acute and chronic pain settings. The current trends in surgical practice, especially ambulatory surgery and enhanced recovery after surgery/fast-track care pathways have profoundly impacted the choices for acute pain management, with an increasing role for adjuvants. Medicinal cannabis and other adjuvants have also become increasingly popular for the management of intractable chronic pain and neuropathic pain owing to the inadequacy of conventional analgesics in these pain states. As clinical and research interest in patient safety and patient satisfaction evolve further development of adjuvant analgesics will be expected to fill the existing gaps in pain management. This review aims to examine the expanding role of analgesic adjuvants in the management of acute and chronic pains, and in the prevention of the transition to chronic pain. In doing so, we conducted an online search primarily on the PUBMED database using the term “analgesic adjuvant” for human studies published in peer-reviewed journals from 2000 to 2022.

Keywords

• ambulatory surgery
• analgesic adjuvant
• cannabis
• neuropathic pain
• opioids