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office_hours:pain:start [2026/02/14 17:09] – andrew2393cnsoffice_hours:pain:start [2026/02/15 03:28] (current) – andrew2393cns
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-====== Pain Management Series ====== +{{ :office_hours:series:pain.png?400 |}}
- +
-{{:pharmatlas:pain_management_banner.jpg?nolink&1200x250}} +
 ===== Overview ===== ===== Overview =====
  
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   * Patient-specific risk factors   * Patient-specific risk factors
  
-This series follows a structured framework:+This series is organized in a structured framework:
  
   Physiology → Classification → Time Course → Syndromes → Drug Classes → Special Populations → Clinical Application   Physiology → Classification → Time Course → Syndromes → Drug Classes → Special Populations → Clinical Application
- 
-Pain treatment must be mechanism-directed. 
  
 ---- ----
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   * Substance P   * Substance P
   * NMDA receptors   * NMDA receptors
-  * Ascending spinothalamic pathways +  * Ascending pathways 
-  * Descending inhibitory pathways (NE & serotonin)+  * Descending inhibitory pathways
  
 ---- ----
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   * Neuroimmune activation   * Neuroimmune activation
   * Reduced descending inhibition   * Reduced descending inhibition
-  * Opioid-induced hyperalgesia 
  
 ---- ----
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 ===== II. Types of Pain ===== ===== II. Types of Pain =====
  
-  * [[pain_management:nociceptive_pain|Nociceptive Pain]] (Somatic & Visceral) +==== Nociceptive Pain ====
-  * [[pain_management:neuropathic_pain|Neuropathic Pain]] +
-  * [[pain_management:nociplastic_pain|Nociplastic Pain]] +
-  * [[pain_management:mixed_pain|Mixed Pain States]]+
  
-Pain classification determines therapy.+See: [[pain_management:nociceptive_pain|Nociceptive Pain]] 
 + 
 +  * Somatic 
 +  * Visceral 
 +  * Inflammatory mediators 
 + 
 +---- 
 + 
 +==== Neuropathic Pain ==== 
 + 
 +See: [[pain_management:neuropathic_pain|Neuropathic Pain]] 
 + 
 +  * Nerve injury or disease 
 +  * Ectopic firing 
 +  * Sodium channel dysfunction 
 + 
 +---- 
 + 
 +==== Nociplastic Pain ==== 
 + 
 +See: [[pain_management:nociplastic_pain|Nociplastic Pain]] 
 + 
 +  * Central sensitization 
 +  * Altered nociception 
 +  * Amplified pain processing 
 + 
 +---- 
 + 
 +==== Mixed Pain States ==== 
 + 
 +See: [[pain_management:mixed_pain|Mixed Pain States]] 
 + 
 +  * Combination of mechanisms 
 +  * Common in chronic pain
  
 ---- ----
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 ===== III. Acute vs Chronic Pain ===== ===== III. Acute vs Chronic Pain =====
  
-  * [[pain_management:acute_pain|Acute Pain]] +==== Acute Pain ====
-  * [[pain_management:chronic_pain|Chronic Pain]]+
  
-Acute pain is typically tissue-driven.   +See: [[pain_management:acute_pain|Acute Pain]] 
-Chronic pain often reflects nervous system remodeling.+ 
 +  * Protective 
 +  * Tissue injury driven 
 +  * Short duration 
 + 
 +---- 
 + 
 +==== Chronic Pain ==== 
 + 
 +See: [[pain_management:chronic_pain|Chronic Pain]] 
 + 
 +  * Persistent beyond normal healing 
 +  * Nervous system remodeling 
 +  * Central amplification 
 +  * Psychosocial interaction
  
 ---- ----
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 ===== IV. Pain Syndromes ===== ===== IV. Pain Syndromes =====
  
-  * [[pain_management:musculoskeletal_pain|Musculoskeletal Syndromes]] +==== Musculoskeletal Syndromes ==== 
-  * [[pain_management:neuropathic_syndromes|Neuropathic Syndromes]] +[[pain_management:musculoskeletal_pain|Musculoskeletal Pain]] 
-  * [[pain_management:centralized_pain_syndromes|Centralized Syndromes]] + 
-  * [[pain_management:visceral_pain_syndromes|Visceral Syndromes]] +==== Neuropathic Syndromes ==== 
-  * [[pain_management:migraine_headache|Migraine & Headache Syndromes]] +[[pain_management:neuropathic_syndromes|Neuropathic Pain Syndromes]] 
-  * [[pain_management:cancer_pain|Cancer Pain]]+ 
 +==== Centralized Pain Syndromes ==== 
 +[[pain_management:centralized_pain_syndromes|Centralized Pain Syndromes]] 
 + 
 +==== Visceral Pain Syndromes ==== 
 +[[pain_management:visceral_pain_syndromes|Visceral Pain Syndromes]]
  
 ---- ----
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 ===== V. Pharmacologic Drug Classes ===== ===== V. Pharmacologic Drug Classes =====
  
-Pharmacologic therapy must match the dominant mechanism. +Pain pharmacotherapy must match mechanism. This series will cover the drugs that can be used for pain
- +
-Drug classes covered:+
  
-  * [[cardio:anti_inflammatory:nsaids|NSAIDs]] +See: [[pain_management:drug_classes|Pain Pharmacotherapy]]
-  * [[pain_management:acetaminophen|Acetaminophen]] +
-  * [[endocrine:corticosteroids|Corticosteroids]] +
-  * [[neuro:sodium_channel_blockers|Voltage-Gated Sodium Channel Antagonists]] +
-  * [[neuro:anticonvulsants|Antiepileptics (Gabapentinoids & Others)]] +
-  * [[psychiatry:snri|SNRIs]] +
-  * [[psychiatry:tca|Tricyclic Antidepressants]] +
-  * [[neuro:nmda_antagonists|NMDA Receptor Antagonists]] +
-  * [[controlled_substances:opioids|Opioids]] +
-  * [[neuro:alpha2_agonists|Alpha-2 Agonists]] +
-  * [[pain_management:muscle_relaxants|Muscle Relaxants]] +
-  * [[pain_management:topical_agents|Topical Analgesics]] +
-  * [[neuro:triptans|Triptans]] +
-  * [[neuro:cgrp_antagonists|CGRP Antagonists]] +
-  * [[neuro:botulinum_toxin|Botulinum Toxin]] +
-  * [[gi:antiemetics:nk1_antagonists|NK1 Receptor Antagonists]] +
-  * [[pain_management:ngf_antibodies|NGF Antibodies]] +
-  * [[pain_management:cannabinoids|Cannabinoids]]+
  
 ---- ----
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   * Pregnancy   * Pregnancy
   * History of substance use disorder   * History of substance use disorder
-  * Polypharmacy patients 
  
 ---- ----
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   * Diabetic neuropathy   * Diabetic neuropathy
   * Fibromyalgia   * Fibromyalgia
-  * Migraine 
-  * Cancer pain 
   * High-risk opioid patient   * High-risk opioid patient
  
 ---- ----
  
-===== Pharm Reference: Drug Classes & Agents =====+===== Guiding Clinical Principles ===== 
 + 
 +<WRAP round important 80%> 
 +  * • Pain classification determines therapy   
 +  * • Chronic pain often reflects central amplification   
 +  * • Mechanism-directed prescribing improves outcomes   
 +  * • Opioids are powerful but limited tools   
 +  * • Multimodal therapy reduces risk   
 +</WRAP> 
 + 
 +---- 
  
-^ Class ^ Drugs Covered ^ 
-| [[cardio:anti_inflammatory:nsaids|NSAIDs]] | [[cardio:anti_inflammatory:ibuprofen|Ibuprofen]], [[cardio:anti_inflammatory:naproxen|Naproxen]], [[cardio:anti_inflammatory:diclofenac|Diclofenac]], [[cardio:anti_inflammatory:indomethacin|Indomethacin]], [[cardio:anti_inflammatory:celecoxib|Celecoxib]] | 
-| [[pain_management:acetaminophen|Acetaminophen]] | [[pain_management:acetaminophen|Acetaminophen]] | 
-| [[endocrine:corticosteroids|Corticosteroids]] | [[endocrine:prednisone|Prednisone]], [[endocrine:methylprednisolone|Methylprednisolone]], [[endocrine:dexamethasone|Dexamethasone]] | 
-| [[neuro:sodium_channel_blockers|Sodium Channel Antagonists]] | [[neuro:local_anesthetics:lidocaine|Lidocaine]], Suzetrigine | 
-| [[neuro:anticonvulsants|Gabapentinoids]] | [[neuro:gabapentin|Gabapentin]], [[neuro:pregabalin|Pregabalin]] | 
-| [[neuro:anticonvulsants|Other Antiepileptics]] | [[neuro:carbamazepine|Carbamazepine]], [[neuro:oxcarbazepine|Oxcarbazepine]], [[neuro:lamotrigine|Lamotrigine]] | 
-| [[psychiatry:snri|SNRIs]] | [[psychiatry:duloxetine|Duloxetine]], [[psychiatry:venlafaxine|Venlafaxine]] | 
-| [[psychiatry:tca|TCAs]] | [[psychiatry:amitriptyline|Amitriptyline]], [[psychiatry:nortriptyline|Nortriptyline]] | 
-| [[neuro:nmda_antagonists|NMDA Antagonists]] | [[neuro:ketamine|Ketamine]], [[controlled_substances:methadone|Methadone]] | 
-| [[controlled_substances:opioids|Opioids]] | [[controlled_substances:morphine|Morphine]], [[controlled_substances:oxycodone|Oxycodone]], [[controlled_substances:hydrocodone|Hydrocodone]], [[controlled_substances:fentanyl|Fentanyl]], [[controlled_substances:buprenorphine|Buprenorphine]], [[controlled_substances:tramadol|Tramadol]], [[controlled_substances:tapentadol|Tapentadol]] | 
-| [[neuro:alpha2_agonists|Alpha-2 Agonists]] | [[cardio:clonidine|Clonidine]], Dexmedetomidine | 
-| [[pain_management:muscle_relaxants|Muscle Relaxants]] | [[neuro:cyclobenzaprine|Cyclobenzaprine]], [[neuro:tizanidine|Tizanidine]], [[neuro:baclofen|Baclofen]] | 
-| [[pain_management:topical_agents|Topical Agents]] | [[neuro:local_anesthetics:lidocaine|Topical Lidocaine]], Capsaicin | 
-| [[neuro:triptans|Triptans]] | Sumatriptan, Rizatriptan | 
-| [[neuro:cgrp_antagonists|CGRP Antagonists]] | Ubrogepant, Rimegepant | 
-| [[neuro:botulinum_toxin|Botulinum Toxin]] | OnabotulinumtoxinA | 
-| [[gi:antiemetics:nk1_antagonists|NK1 Antagonists]] | [[gi:antiemetics:aprepitant|Aprepitant]] | 
-| [[pain_management:ngf_antibodies|NGF Antibodies]] | Tanezumab, Fasinumab | 
-| [[pain_management:cannabinoids|Cannabinoids]] | THC formulations, CBD formulations | 
office_hours/pain/start.1771088996.txt.gz · Last modified: by andrew2393cns