Evidence and consensus recommendations for the pharmacological management of pain in India

Abstract

Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events – particularly with opioids and surgical methods of analgesia – are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case–control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.

A cross-sectional web-based survey of medical practitioners in India to assess their knowledge, attitude, prescription practices, and barriers toward opioid analgesic prescriptions

“…[353637] Indian medical practitioners have vocalized the need to have culturally appropriate guidelines that are created keeping in mind, the regulatory policies and lack of prior training opportunities. [10383940] The assessment of knowledge showed that most participants (71%) accurately expressed that opioid analgesics should be the mainstay of moderate-to-severe cancer pain treatment, and this response was significantly associated with having prior knowledge of the WHO ladder. Studies in the Southeast Asian region and assessments of prescription patterns for Indian cancer patients too have shown that most of them received opioid analgesics.…”

Tramadol/Diclofenac Fixed-Dose Combination: A Review of Its Use in Severe Acute Pain

“…The current armamentarium for pain management comprises multiple options, the majority based on monomodal mechanisms of analgesia [19,20]. However, acute pain is multidimensional in nature, involving sensory, affective, cognitive, and behavioural aspects.…”

“…However, acute pain is multidimensional in nature, involving sensory, affective, cognitive, and behavioural aspects. Therefore, achieving adequate pain control with a single drug may not be beneficial [19,20]. Moreover, most analgesics exhibit a ceiling of efficacy and have significant safety concerns [21].…”

Consumption pattern of gabapentinoids in a tertiary health-care system: a five year study from 2012-2017

“…11,[14][15] Various adjuvant analgesics antiepileptics (Phenytoin, oxcarbamazepine, lamotrigine, topiramate, gabapentin, pregablin), antiarrythmics (Lignocaine and mexiletine) and clonidine, an alpha-2-agonist are commonly used for postherpetic neuralgia, trigeminal neuralgia and diabetic neuropathy. 16 Baclofen and tizanidine, the antispasmodic agents are routinely used against chronic pain. 10,16 A number of drug classes are often utilized for tackling chronic pain, but all the groups tend to produce some adverse effects.…”

“…16 Baclofen and tizanidine, the antispasmodic agents are routinely used against chronic pain. 10,16 A number of drug classes are often utilized for tackling chronic pain, but all the groups tend to produce some adverse effects. Hence, there is a need to look into new group of drugs.…”