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Adjuvant Analgesics in Cancer Pain Management

^a Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York, USA; ^b Interdisciplinary Pain and Palliative Care and Integrative Medicine Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA

Correspondence: Russell K. Portenoy, M.D., Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, First Avenue at 16th Street, New York, New York 10003, USA. Telephone: 212-844-1505; Fax: 212-844-1503; e-mail: rportenoy{at}bethisraelny.org; website: www.stoppain.org

Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, ₂-adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions.

Key Words. Pain • Cancer • Adjuvants • Analgesics • Anticonvulsants • Antidepressants

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