Depending on the type of pain the patient is experiencing, there are several methodologies and pharmacologic agents that can be used. [1] Recall that all pain has some level of inflammatory mediation. Providers should be prepared to apply the biopsychosocial model to the plan of care and utilize alternatives to opioids for managing pain. [2]
Myofascial pain: Osteopathic Manipulative Medicine, Physical Therapy, Acupuncture, Massage, Stretching, Yoga, Heat, Transcutaneous Electrical Stimulation (TENS)[2]
Nociceptive pain: rest, bracing, compression, topical and injectable anesthetics, ice; oral and topical NSIADs, COX-2 inhibitors.
Neuropathic pain: Serotonin Norepinephrine Reuptake Inhibitors (SNRI), anti-epileptic agents (gabapentin, levetiracetam, carbamazepine); tricyclic antidepressants (amitriptyline, nortriptyline) topical capsaicin
As of January 2025, a new medication has been approved by the FDA for the treatment of moderate to severe acute pain called suzetrigine (Journavx), a sodium channel blocker that acts by reducing pain signal before they reach the brain; it should not be taken concomitantly with strong inhibitors of an enzyme called CYP3A. [1][3]