The place of pharmacological treatment in chronic pain

The processing of nociception involves multiple neural pathways, transmitters and receptors. This suggests that there will never be a single ‘magic bullet’ antinociceptive drug. Optimum pain control, therefore, will require a multimodal approach using several analgesics. Nociceptive pain is more likely to respond to the conventional WHO analgesic ladder analgesics. Neuropathic pain is more likely to respond to ‘adjuvant’ analgesics that reduce the neuronal excitability, which results from partial nerve damage. Often these two groups of drug are used in combination because many chronic pains are a mixture of nociceptive and neuropathic pain. Recent guidelines have allowed analgesic prescribing to be done in a more evidence-based manner and hopefully will standardize treatment of chronic pain. In addition, there are often other multimodal therapies administered simultaneously such as regional blockade, physical and psychological therapies.