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American Society for Action on Pain

UI - 000115

AU - Richlin DM

TI - Nonnarcotic analgesics and tricyclic antidepressants for the treatment of chronic nonmalignant pain

AB - Chronic nonmalignant pain is often characterized by multiple treatment failures, a pattern of

maladaptive behavior, and depression. Often there is a history of inappropriate and excessive use of

medications for pain. Prior and ongoing use of narcotics and sedatives acts to compound and aggravate the

chronic pain syndrome. A first step in treatment is controlled withdrawal of these agents. Nonnarcotic

analgesics, NSAIDs, and tricyclic antidepressants are commonly employed in patients with chronic pain.

Effective use of these agents requires understanding of their pharmacokinetic and pharmacodynamic

properties. Use of a fixed-time schedule is necessary to achieve an effective, sustained therapeutic response.

Careful patient education and monitoring for side effects and toxicity are necessary, particularly in the

elderly and patients with coexisting medical disorders. Incidence of side effects and toxicity may be reduced

by choice of drug and modification of dosing regimen. Nonnarcotic analgesics, TCAs, and NSAIDs are

seldom effective by themselves in resolving the pain and distress of patients with chronic nonmalignant pain.

This is particularly true when maladaptive behavior coexists. A comprehensive multimodal pain management

program encompassing additional pain-relieving strategies and behavior-modifying techniques should be

considered and utilized in conjunction with medication.

SO - Mount Sinai Journal of Medicine 1991;58:221-22