Time dependent effect of muscimol and baclofen Table 1 and 2 show the pain relieving effect of

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

Pain is a common symptom that is associated with numerous medical issues, including musculoskeletal problems that physical therapist see on a day to day basis. There are several different ways to treat pain and one of them is to provide a means of releasing opioids in the body to alter the pain experience. In fact, there are three different types of opioids: naturally occurring (endogenous or exogenous substances such as natural endorphins or poppy), semisynthetic (exogenous substances that contain both natural and synthetic agents), and synthetic agents (man-made substances used to mimic the effect of natural substances) used to decrease the symptom of pain.1

The availability of prescription painkillers has increased substantially, painkillers are drugs that deal with the nervous system, it blocks pain and the patient will feel a “high”. The most common prescribed drugs

These may include multimodal analgesics, opioids, repositioning, and

which in turn inhibits the second order neurons that transmit the nociceptive signals to the

As mentioned above, opioids are extremely helpful in killing acute and cancer pain. Because opioid receptors are G-protein coupled reactions, the inhibitory G-protein is usually coupled or attached with the receptors (Ghelardini et al., 2015, page 219). The onset of reaction in inhibit the pain is rapid and effective due to multiple inhibitory actions at the terminal site (refer to the previous section of mechanism of action). Besides, the interaction of opioids gradually increases the threshold of pain neuron as well as attenuates the pain subjective evaluation (Ghelardini et al., 2015, page 220).

Although she finds it mildly beneficial, she complained of intense gastric pain while taking ibuprofen. Heather is wary of supplementing with any form of acetaminophen as she felt “loopy,” at one instance which she did not attribute to any other underlying cause (i.e. fever, medication). Heather also has an aversion to opiates, as she does not tolerate the euphoria and confusion while being on them. The option of bupivicaine +/- corticosteroid was presented to treat her SI join pain and to produce a NSAID sparing effect. However, she is afraid of needles therefore this option was not pursued. Rather a trial of Tramadol immediate release, at a dose of 25-50 mg PO at bedtime was provided to Heather. Her SI joint pain was reduced by 30% (9/10 to 6/10) within 30 minutes of starting Tramadol, without any noticeable side effects. There was no effect on her chronic daily headache pain. She started taking tramadol immediate release around the clock, and wore off after 4 hours. Therefore a prescription for Zytram XL (Tramadol CR) was provided to decrease her baseline pain and address end of dose pain. In addition to she was provided an additional repeat of immediate release tramadol for breakthrough pain. Lastly she discontinued use of ibuprofen as her pain relief from Tramadol was

Although the mechanism of action of acetaminophen is unclear, it is generally believed to work the same was as ibuprofen. Ibuprofen and acetaminophen produce therapeutic effects by reversibly inhibiting cyclooxygenase and thus blocking the synthesis of proinflammatory prostaglandins, prostacyclins and thromboxanes from arachidonic acid. The effects of these prostanoids include lowering the pain threshold thereby exaggerating pain perception. Inhibiting the synthesis of these prostanoids increases the pain

In the alleviation of pain in chronic conditions such as cancer and rheumatoid arthritis, opioids are used. The codeine that falls under opioids is ten times less efficient compared to morphine. Some opioid analgesics such as hydromorphone are more potent compared to morphine, reports Rxlist. The opioid drugs act by binding to opioid receptors in the central nervous system. Unlike other analgesics that inhibits cyclooxygenase enzymes involved in mediating the

Acute pain is a strong pain that does not last longer than three months. According to Bryant and Knights (2015), an acute pain gives an extreme feeling soreness associated with injury, surgery and diseases. However, the treatment can reduce the pain in a short period of time. The untreated acute pain may develop to a chronic pain and neuropathic pain. Due to the high level of pain in acute pain, the use of analgesic drugs such as opioid is necessary to control the pain. Filizola and Devi (2012) claim that as opioid drugs like morphine and codeine are highly potent analgesics. However, there are several side effects that influence the medical efficiency of the drugs. Furthermore, as an agonist analgesics, morphine relies on the Opioid Receptors

Adequate pain assessment is essential for measuring the efficacy of treatment in clinical practice, provide patient with target pain treatment, and avoid the high number of non-responders.15 Clinically, valuable pain assessment would associate certain signs and symptoms that comprise the pain phenotype with underlying mechanisms.15 Methods such as quantitative sensory testing, functional imaging, skin biopsies and genetic screening are assessment tools provide valuable information regarding the neurobiology of pain.15 However, these tools are expensive, require technical expertise and not suitable for routine assessment of a patient’s pain.15 Therefore, the purpose of this study is to establish biopsychosocial pain profiling of multiethnic

The main ar-gument of the article is that neuropathic pain is challenging to manage and is a signifi-cant burden on society. The authors highlight how intrathecal drug delivery can be an alternate intervention for neuropathic pain when other methods of treatment fail to re-lieve symptoms. The topics covered in the article are the various medications used to manage neuropathic pain such as opioids, alpha-2 adrenergic agonists, calcium channel blockers, gamma-aminobutyric acid agonists, local anaesthetics, and corticosteroids. Ev-idence shows that intrathecal opioids may provide long term benefits for neuropathic pain, with other medications such as baclofen, ziconotide, bupivacaine, clonidine also showing moderate evidence of effective management of neuropathic

The strength of this recommendation is inconclusive. As practitioners, we should have minimum restraint in following this recommendation and should be on the lookout for new evidence in addition to strongly listening to patient preference. This recommendation is based upon three RCT’s. Two of these studies were of high strength and one was of moderate strength with regard to quality. All three of these studies had moderate applicability. In these studies, pain improvement was not consistently statistical significant (MD = .81, 95% CI -1.76, .14; MD = 2.26, p<.001; MD = -.82, 95% CI -1.247, -.39), and neither was function (MD = 3, 95% CI -1.05, 7.05; MD = 6.54, p=.001). In addition, the authors concluded the clinical significance of these findings were

The experiment was conducted on 75 healthy University of Sydney medical science students of both sexes and varying ages and body types. which involved two different types of induction of pain. The independent variable was the type of drug analgesic (paracetamol or combined with codeine) and the dependent variable was the pain response whilst taking the drug. All participants were given ethical and safety awareness of the experiment, and had a choice to participate. Their medical conditions (i.e. allergies) and any previous morning medication taken were considered prior to allowing them to participate.

According to Hah et al. (2017), several studies have shown that nerve blockade of the central nervous system (neuraxial anesthesia) or peripheral nerves (regional anesthesia) reduce the need for opioids in the immediate postoperative phase. There are two mechanisms through which nerve blockade reduces persistent opioid use. First, nerve blockade works by impeding the transmission of pain during the perioperative phase and thereby stopping central sensitization and chronic neuropathic pain. Second, nerve blocks are effective in treating postoperative pain and are good predictor of persistent opioid use. Similarly, studies found that intravenous local anesthetic such as lidocaine reduces perioperative opioid