Forgotten Analgesics: The Drugs Pain Practitioners Need to Reconsider

 

Pain management - whether acute or chronic - is one of the most difficult medical conditions to treat, and when treatment options are limited, it is the patient who suffers while the clinician bears the burden. painful to try to help the patient. The current opioid crisis in the United States has dramatically changed the pendulum of opioid prescribing practices due to a variety of guidelines, laws, regulations, and policies that are restrictive at both the federal and state levels. Clinicians are challenged

 and most likely hesitant to manage complex pain syndromes in people with medical conditions.

 Not all drug treatment options are feasible for all cases due to patient-specific factors, compulsive medical indications and comorbidities, drug interactions, and even pharmacokinetics. learn. Over time, some pharmaceutical options are taken off the market by the manufacturer, forgotten, or underutilized due to a lack of  knowledge or familiarity by clinicians.

 Orphenadrine citrate:

 Orphenadrine citrate is classified as an antispasmodic whose mechanism of action is unclear, but it is a derivative of diphenhydramine and its activity is thought to be related to the effects of antispasmodics. God. In four placebo-controlled trials, orphenadrine was found to be quite effective in a number of musculoskeletal conditions (acute low back pain, neck pain, nocturnal leg cramps) as well as symptoms of hyperactivity. pain, stiffness and function.²

 Tolperisone:

 Tolperisone is classified as an antispasmodic with lidocaine-like mechanism of action in stabilizing the neural membranes of single and polysynaptic reflexes. nerves of the spinal cord by blocking them in a dose-dependent manner.¹ Tolperisone has been shown to be more effective than placebo for patients with chronic low back pain and there is an overall improvement when used briefly for 21 days, but did not reduce muscle spasms or soreness. shelf life up to 14 days.³ As a skeletal muscle relaxant with fewer CNS side effects than some currently available  analgesics, tolperisone may offer a more promising option for patients.

 Dantrolene sodium:

 Dantrolene is still commercially available in oral and injectable forms and is FDA approved for the treatment of spasticity associated with upper motor neuron disorders such as cerebral palsy, multiple sclerosis, and concussion. spinal cord injury and stroke.

 Non-steroidal anti-inflammatory drugs (NSAIDs):

 NSAIDs are used to inhibit the enzyme cyclooxygenase (COX) which is a  membrane-bound hemoprotein with a dual function that catalyzes the reduction of arachidonic acid to cyclic endoperoxide by the bis-dioxygen process for biosynthesis of prostaglandins, prostacyclin and thromboxane