Fixed-dose combinations at the front line of multimodal pain management: perspective of the nurse-prescriber

Abstract

Pain should be treated promptly and effectively to restore the patient to full function, avoid pain chronification, and preserve quality of life. A recent pain specialists' meeting discussed the use of different pharmacological treatment options, such as topical analgesics, nonopioid agents (such as paracetamol and nonsteroidal anti-inflammatory drugs), weak and strong opioids, and fixed-dose combination products in the management of moderate to severe pain from different etiologies. One of the topics discussed in, and subsequent to, this meeting was the role of fixed-dose combination products for nurse-prescribers who are in many ways at the front line of managing both acute and chronic pain syndromes. The panel agreed that proper product selection should take into account the patient's age, condition, type of pain, and comorbidities, as well as balance safety with effectiveness. Although nurse-prescribers need to be aware of cumulative paracetamol dosing, fixed-dose combination products, such as tramadol-paracetamol, may offer important advantages, eg, by providing opioid-sparing without sacrificing efficacy.

Multimodal analgesia in moderate-to-severe pain: a role for a new fixed combination of dexketoprofen and tramadol

“…As a result, analgesic combinations are recommended by the World Health Organization (WHO), American Pain Society (APS), and American College of Rheumatology (ACR) [26][27][28][29] , and are commonly used in clinical practice. Provided the two agents are combined in a fixeddose ratio, the resulting medication may offer additional advantages over extemporaneous combinations, including ease of administration, reduction of pill burden, and/or requirement for lower dosages of the individual components 30 .…”

Multimodal Pain Management for Enhanced Recovery: Reinforcing the Shift From Traditional Pathways Through Nurse‐Led Interventions

“…Multiple physiologic pathways contribute to acute postsurgical pain; thus, optimal pain control involves a balanced approach, using multiple therapies that disrupt different aspects of pain and inflammatory pathways 4,5,7,9‐12 . In contrast to unimodal analgesia, multimodal analgesia combines two or more pharmacologic agents or techniques with different mechanisms of action working synergistically to reduce postsurgical pain 4‐7,13,14 . This combination of modalities can produce more‐effective analgesia than a single agent 6,9,14 and may also address genetic variations (eg, in medication response, pain sensitivity, or metabolism of analgesics) that can limit the efficacy of unimodal analgesia 15 …”

The Current State of Perioperative Pain Management: Challenges and Potential Opportunities for Nurses

“…Achievement of adequate pain management is a fundamental tenet of good patient care and a key focus of perioperative nurses. In the perioperative setting, uncontrolled pain has a negative effect on patient satisfaction, 4 increases the risk of readmission, 5 prolongs hospital stay, 6 and may lead to the development of chronic postsurgical pain 7,8 …”

“…It is also important to consider potential variations in efficacy and risk profiles of analgesic agents, depending on the surgical procedure 6 . Nurses contribute to the safety and effectiveness of multimodal pain management strategies through their knowledge of the mechanisms of action and possible adverse events (AEs) associated with the analgesics used, timely administration of pain medications, proper assessment and monitoring of the patient, and management of AEs 3,7,40‐43 …”