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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, N -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
Drug | Oral Route | IV Route | Duration | Half-Life |
---|---|---|---|---|
Morphine | 30 mg | 10 mg | 3-4 hr | 2 hr |
Oxycodone | 20 mg | — | 4-6 hr | 4.5 hr |
Hydromorphone | 7.5 mg | 1.5-2 mg | 4-5 hr | 2-3 hr |
Hydrocodone | 30 mg | — | 4-6 hr | 3-4.5 hr |
Codeine | 200 mg | 120 mg | 4-6 hr | 3 hr |
Tapentadol | 75-100 mg | — | 4-6 hr | 4-5 hr |
Fentanyl | — | 100 mcg | 1-2 hr | 1-2 hr |
Buprenorphine | — | 0.4 mg | 6-12 hr | 2.2 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.