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. 2019 Oct;36(10):2618-2637.
doi: 10.1007/s12325-019-01053-x. Epub 2019 Aug 16.

Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus

Giustino Varrassi  1   2 , Eli Alon  3 , Michela Bagnasco  4 , Luigi Lanata  4 , Victor Mayoral-Rojals  5 , Antonella Paladini  6 , Joseph V Pergolizzi  7 , Serge Perrot  8 , Carmelo Scarpignato  9 , Thomas Tölle  10
Affiliations

Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus

Giustino Varrassi et al. Adv Ther. 2019 Oct.

Abstract

Objective: The clinical management of inflammatory pain requires an optimal balance between effective analgesia and associated safety risks. To date, mechanisms associated with inflammatory pain are not completely understood because of their complex nature and the involvement of both peripheral and central mechanisms. This Expert Consensus document is intended to update clinicians about evolving areas of clinical practice and/or available treatment options for the management of patients with inflammatory pain.

Method: An international group of experts in pain management covering the pharmacology, neurology and rheumatology fields carried out an independent qualitative systematic literature search using MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials.

Results: Existing guidelines for pain management provide recommendations that do not satisfactorily address the complex nature of pain. To achieve optimal outcomes, drug choices should be individualized to guarantee the best match between the characteristics of the patient and the properties of the medication. NSAIDs represent an important prescribing choice in the management of inflammatory pain, and the recent results on paracetamol question its appropriate use in clinical practice, raising the need for re-evaluation of the recommendations in the clinical practice guidelines.

Conclusions: Increasing clinicians' knowledge of the available pharmacologic options to treat different pain mechanisms offers the potential for safe, individualized treatment decisions. We hope that it will help implement the needed changes in the management of inflammatory pain by providing the best strategies and new insights to achieve the ultimate goal of managing the disease and obtaining optimal benefits for patients.

Funding: Dompé Farmaceutici SPA and Paolo Procacci Foundation.

Keywords: Adjuvant drugs; Inflammation; Inflammatory pain; NSAIDs; Neurogenic pain; Neuroinflammation; Opioids; Pain.

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Conflict of interest statement

Eli Alon was a consultant of Dompé Farmaceutici SPA and Sanofi. Victor Mayoral-Rojals was a consultant for Dompé Farmaceutici SPA, Esteve, Ferrer, Gruenenthal, Kyowa Kirin, Menarini, Mundipharma, Pfizer, and Takeda. Antonella Paladini has served as a consultant for Molteni Farmaceutici. Joseph V. Pergolizzi has been a consultant for BDSI, Daiichi, Dompé Farmaceutici SPA, Enalare, Hikma, Neumentum, Salix, and US World MEDS. Joseph V. Pergolizzi is a member of the journal’s Editorial Board. Serge Perrot served as a consultant for Astellas, Dompé Farmaceutici SPA, Gruenenthal, Menarini, Merk, MSD, Pfizer, and Sanofi. Carmelo Scarpignato served as a consultant for Dompé Farmaceutici SPA, Gruenenthal, Menarini, Molteni, Pfizer, Shionogi, and Takeda. Thomas Tölle was a consultant of: Air Liquide, Almiral, Dompé, Gruenenthal, Hexal, Lilly, Menarini, Mundipharma, Novartis, OrphanPharma, Pfizer, and TAD Pharma. Michela Bagnasco is an employee of Dompé Farmaceutica SPA. Luigi Lanata is an employee of Dompé Farmaceutica SPA. Giustino Varrassi served as a consultant for Abbott, Dompé Farmaceutici SPA, Malesci, Menarini, Molteni, Mundipharma, Shionogi, and Takeda. Giustino Varrassi is the Pain Management Section Editor for the journal.

Figures

Fig. 1
Fig. 1
Clinical and experimental evaluation of analgesic and antiinflammatory effects of several NSAIDs. Data extracted from [73]
Fig. 2
Fig. 2
Risk factors for NSAID-associated GI effects, including the relative risk (RR), were different for several NSAIDs. Redrawn from: 1. Salvo et al. [115]; 2. Castellsague et al. [117]. GI gastrointestinal, NSAID non-steroidal antiinflammatory drug, RR relative risk, SSRI selective serotonin reuptake inhibitor
See this image and copyright information in PMC

References

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