Nonopioid Agents for Treatment of Acute and Subacute Pain

To review the available nonopioid options for alleviating pain. The various categories of adjuvant agents and their mechanisms of action in the treatment of pain are summarized. Adjuvant therapies that directly diminish acute and subacute pain, those that counteract the side effects of opioids, and those that help manage concurrent psychiatric symptoms are discussed, and their recommended doses and adverse effects are outlined. Adjuvant medications such as nonopioid analgesics (including acetaminophen and nonsteroidal anti-inflammatory drugs), corticosteroids, anticonvulsants, antidepressants, muscle relaxants, and antispasmodics can directly decrease pain. The three most common problems associated with opioid therapy are nausea, constipation, and sedation. Adjuvant drugs such as antiemetics, laxatives, and psychostimulants may counteract these side effects of opioids and thereby enable patients to tolerate adequate doses of opioid agents to relieve pain. In addition, adjuvant medications such as antidepressants, anxiolytics, and antipsychotics can be used to treat concomitant psychiatric symptoms that develop and aggravate existing pain. The choice of agents must be individualized to the patient's particular pain condition; once therapy has been initiated, the response must be continually monitored to optimize control of pain. Nonopioid adjuvant agents should be considered an integral part of the management of acute and subacute pain.