Posted by Heidi/Mermie The cardiac antiarrythemic Mexitil has a similar mechanism of action. It has been used successfully for pain reduction as well. Catapres has agonist effects on the alpha receptors in both the central and peripheral nervous system. As agonists, they block the release of norepinepherine from sympathetic nerve endings. As a result of the weakened sympathetic response to an inciting stimulus, pain reduction occurs. In addition, Catapres has an agonist effect on opiod receptors, which in turn blocks the release of substance P. Both of these effects reduces the pain experience. Procardia's calcium channel blocking effect causes blood vessel wall relaxation. By increasing oxygen o the tissues, it therefore has a second mechanism of action to reduce pain. Unlike Clonidine, however, it does not work at the alpha or opiod receptors. Zanaflex is an alpha agonist muscle relaxor. Because it reduces reflex activity within the spinal column, it reduces the release of excitatiory amino acids. This in turn inhibits the release of substance P and results in less stimulus for upgrading of NMDA activity. Guanethidine is a drug that depresses the function for the postganglionic adrenergic fibers. Its major effect is to inhibit responses to sympathetic activation. Guanethidine also has considerable anesthetic activity. Bretylium is another example of a drug in this class. Elavil, Pamelor and Deseryl are antidepressants with known pain relieving properties. They block the reuptake of Their sedating side effect probably plays a role in pain reduction as well. Lidoderm and Emla Patches are topical anesthetics that reduce pain via their soium channel blocking activity. Capsacin cream inhibits the release of substance P. Antivirals such as Amantidine and Zovirax can reduce immune response related neuropathic pain. Plavix, an antiplatlet agent and Pletal a vasodialating drug used for claudication can reduce pain by facilitating oxygen delivery to the tissues. Trental, by increasing red blood cell pliability has been used with success as well. Naturally co morbid disease management and good nutrition facilitates healing and nerve membrane stability. Another example of co morbid disease management that may have a large impact on pain is hidden infection. When infection is present, appropriate use of certain antibiotics can provide dramatic relief. This is especially true for those who have a predisposition to rheumatic conditions. While this is only a brief review of non-narcotic pain relieving medications, it should be clear that there is an important role for pain management with these agents. As our understanding of the numerous mechanisms that affect the pain experience increases we should expect to see more pharmacologic approaches for it's treatment that are either receptor, voltage gate or co morbid disease driven.tresearchteam!M!
on 8/27/2007, 4:03 am
Examples include the anti seizure drugs Neurontin, Tegretol, Depakote and Dilantin.
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