About Initiative
Point of Care
Webcast on Demand

Live webcast
Jointly sponsored by
University of Kentucky
College of Pharmacy
and Vemco MedEd

This activity is supported
by an educational grant from
Janssen Pharmaceuticals, Inc.,
administered by
Janssen Scientific Affairs, LLC

The online tutorial series with a case reinforces practical application of tools and competencies acquired during the live activity. Each tool is a combination of essentials in clinical practice, links to relevant scientific publications, and printable handout material for reference. Clinical Case following the online tutorials gives the learners an opportunity to earn extra CE credit upon completion.

  1. Differentiating Types of Pain
  3. Assessment of Pain
  5. Know Your Drugs: Non-Opioids
  7. Know Your Drugs: Opioids
  9. Minimizing Adverse Effects
  11. Clinical Case

Know Your Drugs: Non-Opioids

The goal of chronic pain management is to decrease pain while improving function and reducing psychosocial suffering while minimizing adverse events. An important approach to achieve this goal is utilizing a multimodal treatment approach. Multimodal interventions utilize more than one type of therapy (e.g., an opioid with a co-analgesic/adjunctive medication) in order to address the pain through multiple mechanisms. To implement multimodal treatment strategies, it is important for clinicians to understand the various treatment options when managing chronic pain.


Drug/Drug class Benefits Risks
  • Weak anti-inflammatory activity
    (COX-1 inhibitor)
  • Addresses the central pain mechanism: good evidence to suggest activity in descending serotonergic pain pathway
  • Hepatotoxicity
    • Increased risk with acute or chronic alcohol use
    • Chronic daily use ≥ 4000 mg/day
  • Limited evidence on renal toxicity
  • Strong anti-inflammatory activity with oral NSAIDs but need to be prescribed with a proton pump inhibitor or misoprostol
  • Multiple clinical trials demonstrating safety and efficacy of topical NSAIDs for superficial joint pain in elderly with minimal evidence of adverse effects (e.g. renal impairment, hypertension, bleeding)
  • Adverse effects including GI bleeding, platelet inhibition, hypertension, renal toxicity, aspirin cardioprotection interference
  • Drug interactions with SSRIs, diuretics, ACE inhibitors, corticosteroids

Adjunctive Medications

Serotonin norepinephrine reuptake inhibitors (SNRIs)
Cornerstone in treatment of fibromyalgia, post-herpetic neuralgia, painful poly-neuropathy, and chronic musculoskeletal pain Examples include:
  • Duloxetine
  • Milnacipran
  • Venlafaxine
Tricyclic antidepressants (TCAs)
  • Clinical evidence demonstrates efficacy in treatment of neuropatic pain
  • Risk: anticholinergic side effects with high doses
Examples include:
  • Amitriptyline
  • Nortryptyline
  • Clinical evidence suggests efficacy in the treatment of neuropathic pain and fibromyalgia with some agents
  • Inconclusive results on treatment of neuropathic pain with topiramate, levetiracetam, valproate, and oxcarbazepine
Examples include:
  • Gabapentin
  • Pregabalin
  • Lamotrigine

Suggested Reading:

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