Pharmacologic interventions at the spinal cord and higher centers that inhibit pain

Pharmacologic interventions at the spinal cord and higher centers that inhibit pain

Any drug or anesthetic approach that reduces excitatory input from primary afferents and second-order neurons results in analgesia.

These drugs include opioids, serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, -methyl d -aspartate (NMDA) antagonists, calcium channel blocking drugs such as gabapentin for L-type channels, and Ziconitide ® (omega-conopeptide) for N-type channels.

Examples of these drugs are listed in the below table .

Equianalgesic Dose Conversions

DrugOral RouteIV RouteDurationHalf-Life
Morphine30 mg10 mg3-4 hr2 hr
Oxycodone20 mg4-6 hr4.5 hr
Hydromorphone7.5 mg1.5-2 mg4-5 hr2-3 hr
Hydrocodone30 mg4-6 hr3-4.5 hr
Codeine200 mg120 mg4-6 hr3 hr
Tapentadol75-100 mg4-6 hr4-5 hr
Fentanyl100 mcg1-2 hr1-2 hr
Buprenorphine0.4 mg6-12 hr2.2 hr IV; 37 hr SL

Data from Knotkova H, Fine PG, Portenoy RK: Opioid rotation: the science and limitations of the equianalgesic dose table. J Pain Symptom Manage 38(3):426-439, 2009.

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