The Safe and Rational Use of Analgesics: Non-opioid Analgesics

Non-opioid medications have long been part of a comprehensive pain management strategy for acute conditions. Many pharmacologic agents that fall into this heterogeneous group are inexpensive and readily available, and are perceived to have a lower risk of adverse events when compared to opioids. This narrative review provides an overview of several classes of non-opioid analgesics and discusses some of the evidence that examines their effectiveness. Three cases are used to highlight specific situations in which non-opioid medications could be considered. NSAIDs and acetaminophen have been demonstrated to be effective compared to placebo in a variety of settings for the treatment of acute and chronic pain. Tricyclic antidepressants, selective serotonin reuptake inhibitors, and gabapentin are commonly used for chronic neuropathic pain. Important safety considerations exist, and clinicians should be aware of the contraindications and potential for adverse events for any non-opioid analgesic they plan to prescribe.