Active Ingredients: Gabapentin
Five studies have demonstrated a decreased need for opioids with continuous cryotherapy, 148, 150, 151, 154, 156 one study showed a lower consumption of pain medication with the use of ice packs, 157 and 5 RCTs failed to show a difference between these 2 cryotherapy modalities.
Variables such as cryotherapy source, temperature, duration, and frequency can vary drastically from treatment groups in the same study, as well as study to study, making the assessment on the magnitude of effect difficult to determine.
Because of the current literature's methodological heterogeneity, we are unable to favor 1 method of cryotherapy application, protocol, or both. Like most therapeutic interventions, cryotherapy can result in complications.
Nerve palsies have been reported in the literature, mostly involving more superficial nerves such as the peroneal nerve, lateral femoral cutaneous nerve, ulnar nerve, and supraclavicular nerve.
Care must be taken to provide sufficient insulation between the skin and the cryotherapy source, especially in patients with minimal subcutaneous fat. Nerve injuries can range from brief paresthesias to complete axonotmesis.
Overall, the body of literature provides preliminary support for use of cryotherapy for acute pain management.
However, future studies should focus on determining the most efficacious method of application and protocol for cryotherapy.
Opioids are also associated with adverse clinical events. Patient comfort and safety must be carefully balanced when prescribing opioids. Because of the potential for misuse of all opioids, the panel recommends that the prescriber should use the lowest effective dose for the shortest period possible strong recommendation, high-quality evidence.
Commonly written prescriptions with ranges of dose and duration can allow tripling of daily dose to levels consistent with adverse events strong recommendation, low-quality evidence.
Opioids are the most commonly used medications for treatment of most severe pain conditions.
Regardless of the formulation used, there is always a risk of adverse events, as well as abuse, addiction, or both.
The number and severity of adverse events from opioids are related to their potency, half-life, and mode of use.
The number of milligrams in the dosage is not an indication of how strong the medication might be. Currently, immediate-release opioids are prescribed at a significantly higher rate than extended-release options.
Immediate-release opioids, which cause serum opioid levels to rapidly increase and decrease with a shorter half-life, have a shorter period of pain relief.
This results in less fluctuation in serum drug levels, keeping opioid concentration in the therapeutic range. More specifically, combining opioids with nonsteroidal anti-inflammatory drugs NSAIDs has been shown to be more effective than opioids alone.
Taking any of these formulations with food does not change the maximum dose of the medication delivered, although when taken after a high fat meal, the time to maximum concentration is delayed. The majority of the literature on safety and efficacy of opioids is in regard to chronic pain from both malignant and nonmalignant conditions.