5 Adjuvant Medications for Pain
Learn how adjuvant medications target particular contributors to pain, which medication classes may be used, and how benefits, side effects, and interactions shape safe treatment.
What adjuvant medications do
are medicines developed mainly for purposes other than pain relief that can also reduce particular kinds of pain. They may be used alone or alongside nonopioid analgesics or opioids.
These medicines are not interchangeable and are not appropriate for every pain condition. Their usefulness depends on the pain mechanism and the person’s health, other medicines, and treatment goals. For , several medication classes may help, but individual benefits and side effects vary.
Medication classes for nerve pain
Several medication classes may be selected for . The choice depends on the type of pain and the individual’s circumstances.
SNRIs such as duloxetine and tricyclic (TCAs) such as amitriptyline may help . A medicine from these classes may be useful even when the person is not being treated for depression. SNRIs can cause nausea or dizziness; TCAs can cause dry mouth, sleepiness, and dizziness, which may increase fall risk, especially in older adults. Review interactions and other conditions before use.
Gabapentin and pregabalin are commonly used for nerve pain, including pain associated with diabetes or shingles. Dizziness, sleepiness, and swelling can occur, and doses may need adjustment for kidney function. These medicines can cause serious breathing problems in people with risk factors, particularly when combined with opioids or other .
Lidocaine patches or capsaicin cream or patches may help localized peripheral nerve pain. Applying medicine to a limited painful area can reduce whole-body exposure compared with an oral medicine. Skin irritation or a temporary burning sensation may occur. Use these products only as directed and avoid contact with the eyes and broken skin. Topical treatments may be useful when oral medicines cause troublesome effects.
Treatments for selected pain causes
Some medicines are chosen for a particular diagnosis or pain source rather than for pain in general.
such as dexamethasone may be used in selected cases when swelling or inflammation contributes to pain, including some cancer-related pain. Risks depend on dose and duration; prolonged use can cause serious effects, so treatment should be monitored by a clinician.
When cancer has spread to bone, a clinician may consider bone-targeted treatment as part of the pain plan. These and other condition-specific treatments require assessment and monitoring, and are not routine substitutes for other analgesics.
Using adjuvant medications safely
A clinician selects an adjuvant by matching the medicine to the suspected pain mechanism—for example, considering a nerve-pain medicine for burning or tingling pain—and reviewing the person’s other conditions and medicines. Treatment is reassessed for meaningful improvement in pain and daily function, as well as adverse effects.
Do not increase, combine, or stop prescription medicines without advice from the prescriber. Take special care with combinations of medicines that cause sleepiness. Gabapentin or pregabalin combined with an opioid or another central nervous system depressant can increase sedation and the risk of dangerous breathing problems.
Unusual extreme sleepiness, difficulty waking, or slow, shallow, or difficult breathing requires urgent medical attention. More generally, match treatment to the pain and the individual, monitor benefits and harms, and review medicine interactions.