European Journal of Biomedical and Pharmaceutical Sciences

CANNABIS AND OTHER ADJUVANTS: THEIR IMPLICATIONS IN MODERN MANAGEMENT OF PAINS

Ifezulike C. C., Azikiwe C. C. A.*, Nwosu A., Chukwurah I., Enye J. C. and Anowi C. F.

ABSTRACT

Pains have recently been defined as unpleasant sensory and emotional experiences associated with, or resembling that associated with actual or potential tissue damage. Pain may arise from a disease process or healthcare interventions and adversely affects multiple organ systems far from its site of location. Effective pain relief is highly desirable for the patients and healthcare providers as it impacts on outcome and improves quality of life. Conventional analgesics have traditionally been the mainstay of pain management, but unsatisfactory pain relief and troubling unwanted effects have led to the unending search for more efficacious and safer remedies. Adjuvant analgesics are drugs with beneficial analgesic effect but, primarily not developed as analgesics. The use of adjuvants in augmenting analgesia and in the management of refractory chronic pain is not new. Opioids have been the mainstay of severe acute postoperative pain associated with surgery but the troubling unwanted effects such as nausea, vomiting, respiratory depression, drowsiness, constipation and pruritis have continued to be of concern as they impair recovery and rehabilitation. Analgesic adjuvants enable better pain management with reduction in opioid dose and their concomitant unwanted effects. Neuropathic pain and other forms of chronic pain present a peculiar challenge to healthcare with their epidemiological enormity and associated disability thus, shortcomings of conventional analgesics are more glaring. Consequently, recommendations for multimodal analgesia have been widely canvassed with the understanding that their different mechanisms of action will provide coverage of a wider spectrum of pain inputs, enhancing efficacy by synergism. Conclusively, the current trends in surgical practice, especially the relentless expansion of ambulatory surgery and enhanced recovery after surgery (ERAS)/fast-track care pathways have profoundly impacted the choices in pain management. The direct and indirect effects of prescription opioid on the opioid epidemic and the sharp rise in deaths from opioid overdose is also of increasing concern and have necessitated a critical review of their risk-benefit analysis and ignited the search for more efficacious and safer alternatives. As clinical and research interests in patients’ safety, satisfaction and quality of life evolve, further development of adjuvant analgesics will be expected to fill the existing gap in pain management. Expectedly too, as more jurisdictions approve a legal framework for its use, the intense interest in medicinal cannabis which is increasingly becoming popular in management of intractable chronic and neuropathic pains could be better explored.

Keywords: Pains, Analgesics, Adjuvants, Opioids, Cannabis, Neuropathic pains.