Chapter

Drug synergy and sequencing

Edited by Michael I. Bennett

in Neuropathic Pain

Second edition

Published on behalf of Oxford University Press

ISBN: 9780199563678
Published online May 2011 | e-ISBN: 9780199607426 | DOI: http://dx.doi.org/10.1093/med/9780199563678.003.0018

Series: Oxford Pain Management Library

Drug synergy and sequencing

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• Combinations of drugs that work through different mechanisms can result in additive or synergistic effects that may improve control of pain, reduce side-effects, or both • Most evidence comes from studies of co-analgesics with opioids and is derived from both animal and clinical research • Although number needed to treat (NNT) is used to compare drug effectiveness, this method may miss some benefits, overestimate reliability (if confidence intervals are wide), and may detract from number needed to harm (NNH) • Stepwise or parallel approaches to drug combinations have equal merit • First-line approaches can be initiated in primary care but second- and third-line approaches will require increasingly close liaison with specialist pain management services.

Chapter.  2897 words. 

Subjects: Anaesthetics ; Pain Medicine

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