Active Ingredients: Gabapentin
Therefore, communication with both patient and their caregivers, including reasons for withdrawing medication and clear explanation of the entire pain management plan and outcome expectations, is essential, with confirmation that this information has been understood.
If the patient is not fully committed to the structured pain management plan, improvement in outcomes is unlikely. Pharmacological sleep management Sleep is a critical component of treatment and sleep management aims to ensure sufficient quantity of good quality sleep.
However, this should be limited to the shortest time possible ie, less than 2 weeks, with withdrawal as pain and function improve.
Reasons for choosing these drugs should be discussed with the patient, including that the duration of use will be limited to a certain period of time, which must be specified.
Thereafter, if sleep remains a problem, short-term intermittent use of sedative antidepressants eg, mirtazapine, trazodone is preferred.
Because of potential for adverse effects, long-term use of benzodiazepines should be avoided Box 6.
Patients who are already taking benzodiazepines should preferably be slowly weaned over approximately a month until the medication can be discontinued altogether. Box 6 Concerns associated with long-term use of benzodiazepines Refer to pain clinician If the steps listed above are not successful, referral to a pain clinician or multidisciplinary pain clinic is recommended.
However, with an individualized biopsychosocial management plan, it is usually possible to relieve at least some of the pain and improve function and quality of life. Managing pain takes time and needs to be done in partnership with the patient.
Careful communication is essential to manage expectations, encourage a healthy lifestyle and to explain why some medications need to be stopped or changed. Nevertheless, with a little extra effort, the systematic approach described in this article can be extremely rewarding for both health care providers and their patients.
Acknowledgments Writing was supported by an unrestricted grant from Cipla.
The content and writing was independent of the sponsor. SS reports grants from Cipla. References 1. Classification of Chronic Pain.
Voscopoulos C, Lema M. Abstract Background. The role of amitriptyline in musculoskeletal pain is not as clearly defined as in classical neuropathic pain conditions.
To assess the efficacy and effectiveness of amitriptyline in the treatment of pain in musculoskeletal complaints. Included studies were assessed for risk of bias. Outcomes of interest were pain reduction and function improvement.
Of the 2066 articles identified, seven were finally included. These studies were performed in patients with low back pain 4, rheumatoid arthritis 2, and patients with arm pain from repetitive use 1.