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Leaving Plenty of Unmet Need to Be Addressed
19
Relistor (Progenics/Wyeth);
Tapentadol Constipation, (J&J), sedation, DOR
agonists confusion, (Adolor/Pfizer);
respiratory
abuse-deterrent depression, mental opioids clouding,
(King/Alpharma/Acura,
renal colic, tolerance to
prolonged use and risk of
Pain Therapeutics, Acurox)
abuse, misuse, addiction.
Gastrointestinal ulcers,
stomach bleeding,
Celebrex tinnitus (Pfizer)
PN400
(Nexium/naproxen),
AstraZeneca/Pozen
Naproxcinod (NicOx)
Gastric erosion, peptic ulcer,
Topical NSAIDs
inflammation of the duodenum and
of the colon, renal toxicity with
prolonged use
Step 1: Mild Pain (1-3/10)
• Aspirin (ASA)
• Acetaminophen (APAP)
• Nonsteroidal
anti-inflammatory drugs (NSAIDs)
• +/- Adjuvants
World Health Organization
© Defined Health, 2009
Pain Insight Briefing
Step 2: Moderate Pain (4-6/10)
• APAP or ASA +
– Codeine
– Hydrocodone
– Oxycodone
– Dihydrocodeine
– Tramadol (not available
with APAP or ASA)
– +/- Adjuvants
Step 3: Severe Pain (7-10/10)
• Morphine
• Hydromorphone
• Methadone
• Levorphanol
• Fentanyl
• Oxycodone
• +- Nonopiod analgesics
• +/-Adjuvants
•Adjuvant Therapy:
– Anticonvulsants
– Antidepressants
– Corticosteroids
– Dermal analgesics
– Muscle relaxants
– Stimulants