Table 1.
Examples and characteristics of common pharmacologic agents currently used in chronic pain management [77].
| Type | Class | Example(s) | Molecular Mechanism(s) |
|---|---|---|---|
| Nonopioid analgesic | Nonselective NSAIDa | Asprin Naproxen Ibuprofen |
COXb-l,2 inhibition |
| Nonopioid analgesic | Selective NSAIDa | Celecoxib | COXb-2 inhibition |
| Nonopioid analgesic | N/A | Acetaminophen | Prostaglandin synthesis inhibition (mechanism unknown) |
| Scheduled opioid analgesic | Agonist | Morphine1 Oxymorphone2 Codeine3 Fentanyl4 |
mu-opioid receptor binding (strong)1,2,3,4 kappa-opioid receptor binding (weak)1,3,4 delta-opioid receptor binding (weak)1,2,3 |
| Scheduled opioid analgesic | Partial agonist | Buprenorphine | mu-opioid receptor binding (strong) kappa-opioid receptor binding (strong) delta-opioid receptor binding (strong) |
| Scheduled opioid analgesic | Agonist-antagonist | Pentazocine Butorphanol |
kappa-opioid receptor binding (strong agonist) mu-opioid receptor binding (weak antagonist) |
| Nonscheduled opioid analgesic | Agonist | Tramadol | mu-opioid receptor binding; norepinephrine/serotonin reuptake inhibition |
| Nonscheduled opioid analgesic | Agonist-antagonist | Nalbuphine | kappa-opioid receptor binding (strong agonist) mu-opioid receptor binding (partial antagonist) delta-opioid receptor binding (weak) |
| Nonscheduled opioid analgesic | Antagonist | Naloxone | mu-opioid receptor binding (strong) kappa-opioid receptor binding (strong) delta-opioid receptor binding (strong) |
| Adjuvant analgesic (Antidepressant) | Tricyclic antidepressant | Amitriptyline Nortriptyline |
Na+ ion channel inhibition; NMDAc receptor blockade (non-neuroprotective) |
| Adjuvant analgesic (Antidepressant) | sSNRId | Venlafaxine Duloxetine |
Serotonin/norepinephrine reuptake inhibition |
| Adjuvant analgesic (Anticonvulsant) | N/A | Carbamazepine1 Pregabalin2 Neurontin2 |
Na+ ion channel inactive state stabilization1 VGCCe alpha-2-delta subunit binding2 |
| Skeletal muscle relaxant | N/A | Cyclobenzaprine | 5-HT2 receptor antagonist |
| Local anesthetic | N/A | Lidocane 5% patch | Na+ ion channel blockade |
a
nonsteroidal anti-inflammatory drugs
b
cyclooxygenase
c
N-methyl-D-aspartate
d
selective Serotonin/Norepinephrine Reuptake Inhibitor
e
voltage-gated calcium ion channel