ABSTRACT
Adjuvant medications include anticonvulsants, membrane stabilizers, N-methyl-D-aspartate antagonists, alpha-2 agonists, GABAnergic medications, and other agents including the antidepressants and neuroleptics. An important concept is multimodal (or balanced) analgesia, which is beneficial to both acute and chronic pain. This entails a rational combination of several analgesics, which have differing mechanisms of action to obtain improved efficacy and/or tolerability and safety when compared to similar or equianalgesic doses of a single drug. Aspirin, the prototypical nonsteroidal anti-inflammatory medications, has anti-inflammatory and antipyretic properties, along with its pain-relieving properties. Acetaminophen, or N-acetyl-para-amino-phenol (APAP) appears to work centrally; its mechanism of action appears far more complex than initially thought. Oral APAP has efficacy in the prevention of the development of hyperalgesia induced via direct activation of algetic spinal receptors. Muscle relaxants are given for acute soft tissue spasm/pain by some clinicians. They are probably best utilized during the first one to three weeks post injury.
