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Review
. 2006 Spring;11(1):11-38.
doi: 10.1155/2006/642568.

The pharmacotherapy of chronic pain: a review

Mary E Lynch  1 , C Peter N Watson
Affiliations
Review

The pharmacotherapy of chronic pain: a review

Mary E Lynch et al. Pain Res Manag. 2006 Spring.

Abstract
in English, French

The past two decades have contributed a large body of preclinical work that has assisted in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. In this context, it has been recognized that effective treatment of pain is a priority and that treatment often involves the use of one or a combination of agents with analgesic action. The current review presents an evidence-based approach to the pharmacotherapy of chronic pain. Medline searches were done for all agents used as conventional treatment in chronic pain. Published papers up to June 2005 were included. The search strategy included randomized, controlled trials, and where available, systematic reviews and meta-analyses. Further references were found in reference sections of papers located using the above search strategy. Agents for which there were no controlled trials supporting efficacy in treatment of chronic pain were not included in the present review, except in cases where preclinical science was compelling, or where initial human work has been positive and where it was thought the reader would be interested in the scientific evidence to date.

Les deux dernières décennies ont contribué à un vaste ensemble de travaux précliniques qui nous ont permis de mieux comprendre les mécanismes physiopathologiques sous-jacents responsables de la douleur chronique. Dans ce contexte, il est admis que le traitement efficace de la douleur est une priorité et qu’il exige souvent le recours à un agent ou à une association d’agents ayant une action analgésique. La présente analyse présente une démarche probante de la pharmacothérapie de la douleur chronique. Des recherches dans Medline ont été effectuées sur tous les agents utilisés pour le traitement classique de la douleur chronique. Les articles publiés jusqu’en juin 2005 ont été inclus. La stratégie de recherche incluait les essais aléatoires et contrôlés et, si elles étaient disponibles, les analyses systématiques et les méta-analyses. D’autres références ont été obtenues dans la partie des références des articles trouvés à l’aide de la stratégie de recherche précédente. Les agents dont aucun essai contrôlé n’étayait l’efficacité pour le traitement de la douleur chronique étaient exclus de la présente analyse, sauf si les données scientifiques précliniques étaient convaincantes, si les travaux humains initiaux étaient positifs ou si on pensait que les données scientifiques colligées jusque-là étaient intéressantes pour le lecteur.

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Figures

Figure 1)
Figure 1)
Treatment algorithm for pharmacotherapy of chronic non-cancer pain. Note: In general, if one agent in a class of medications does not provide adequate analgesia or causes limiting side effects it is worth pursuing serial trials of one or two others from the class. *See Table 11. NSAID Nonsteroidal anti-inflammatory drug
See this image and copyright information in PMC

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