office_hours:pain:start
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Pain Management Series
Overview
Pain management is one of the most common—and most difficult—challenges in medicine.
Effective treatment requires understanding:
- Pain physiology
- Pain pathophysiology
- Mechanistic classification
- Acute vs chronic transitions
- Pain syndromes
- Pharmacologic targets
- Patient-specific risk factors
This series follows a structured framework:
Physiology → Classification → Time Course → Syndromes → Drug Classes → Special Populations → Clinical Application
Pain treatment must be mechanism-directed.
I. Pain Physiology & Pathophysiology
Pain Physiology
See: Pain Physiology
- Nociceptors
- A-delta vs C fibers
- Peripheral transduction
- Dorsal horn processing
- Substance P
- NMDA receptors
- Ascending spinothalamic pathways
- Descending inhibitory pathways (NE & serotonin)
Pain Pathophysiology
See: Pain Pathophysiology
- Peripheral sensitization
- Central sensitization
- Wind-up phenomenon
- Neuroimmune activation
- Reduced descending inhibition
- Opioid-induced hyperalgesia
II. Types of Pain
III. Acute vs Chronic Pain
Acute pain is typically tissue-driven. Chronic pain often reflects nervous system remodeling.
IV. Pain Syndromes
V. Pharmacologic Drug Classes
Pharmacologic therapy must match the dominant mechanism.
Drug classes covered:
VI. Special Populations
See: Special Populations in Pain Management
- Elderly
- Chronic kidney disease
- Liver disease
- Pregnancy
- History of substance use disorder
- Polypharmacy patients
VII. Case-Based Clinical Applications
See: Case-Based Clinical Applications
- Acute injury
- Chronic low back pain
- Diabetic neuropathy
- Fibromyalgia
- Migraine
- Cancer pain
- High-risk opioid patient
Pharm Reference: Drug Classes & Agents
| Class | Drugs Covered |
|---|---|
| NSAIDs | Ibuprofen, Naproxen, Diclofenac, Indomethacin, Celecoxib |
| Acetaminophen | Acetaminophen |
| Corticosteroids | Prednisone, Methylprednisolone, Dexamethasone |
| Sodium Channel Antagonists | Lidocaine, Suzetrigine |
| Gabapentinoids | Gabapentin, Pregabalin |
| Other Antiepileptics | Carbamazepine, Oxcarbazepine, Lamotrigine |
| SNRIs | Duloxetine, Venlafaxine |
| TCAs | Amitriptyline, Nortriptyline |
| NMDA Antagonists | Ketamine, Methadone |
| Opioids | Morphine, Oxycodone, Hydrocodone, Fentanyl, Buprenorphine, Tramadol, Tapentadol |
| Alpha-2 Agonists | Clonidine, Dexmedetomidine |
| Muscle Relaxants | Cyclobenzaprine, Tizanidine, Baclofen |
| Topical Agents | Topical Lidocaine, Capsaicin |
| Triptans | Sumatriptan, Rizatriptan |
| CGRP Antagonists | Ubrogepant, Rimegepant |
| Botulinum Toxin | OnabotulinumtoxinA |
| NK1 Antagonists | Aprepitant |
| NGF Antibodies | Tanezumab, Fasinumab |
| Cannabinoids | THC formulations, CBD formulations |
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