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Co-analgesics (or adjuvants) are a diverse group of drugs that have been developed for other indications but may have analgesic properties (often outside their product licence). They can be prescribed either alone or in combination with other analgesic drugs. The choice of drug is determined by the type of pain. Co-analgesics are probably most useful in treating neuropathic pain.

Type of Pain

Drug Group

Example

Bone pain

NSAIDs – inhibits prostaglandins Bisphosphonates

Diclofenac Pamidronate, Zoledronic acid

Skeletal muscle spasm (due to tumour involvement)

Benzodiazepines

Diazepam, Clonazepam

Smooth (Intestinal) muscle spasm

Anti-cholinergic / anti-muscarinic

Hyoscine butylbromide

Tenesmus – due to tumour involvement or metastatic involvement of the rectal muscles Raised intracranial pressure – due to tumour or fluid

Corticosteroid Nifedipine

Dexamethasone, Prednisone

Corticosteroid – decreases inflammation around tumour

Dexamethasone

NSAIDs – inhibits prostaglandins COX 2 inhibitors

Diclofenac

Celecoxib

Liver capsule stretch pain Corticosteroids – inhibit inflammation NSAIDs COX 2 inhibitors

Dexamethasone

Diclofenac Celecoxib

Neuropathic (nerve)

Antidepressants

Nortriptyline Amitriptyline Gabapentin Valproate Carbamazepine Clonazepam Lignocaine Mexilitine Flecainide

Anti-convulsants

Local Anaesthetic agents Antiarrhythmic agents

Drugs that reduce painful stimuli

Antibiotics

By reducing secondary infection, pain management is improved.

Hormone treatment

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