**6. Pharmacological intervention**

As a result of a nationwide effort to reduce unnecessary opioid use and reduce incidents of patient abuse, clinicians are encouraged to carefully assess their

patient's pain, limit the number of prescribed opioids analgesics and limit further prescribing by evaluating the patient's pain relief and increased functional ability.

The trend to lower usage has had a tremendous impact on opiod use worldwide over the last years. By 2016, paracetamol/hydrocodone, which had been the leading medication prescribed for pain, had dropped from first most prescribed pain medication to the fourth most prescribed drug in the nation, with the volume of prescriptions down to 7.2% in 2015, from 34% in 2012.

In order to facilitate this continuing trend, it is recommended that the following WHO decision ladder and in-depth patient assessment be utilised before requesting or prescribing opioid compounds.

### **7. Multimodal analgesia**

Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to tailor to the individual patient.

Elements of this protocol may include opioids, non-opioid systemic analgesics like paracetamol, non-steroidal anti-inflammatory drugs, gabapentins, ketamine, and local anaesthetics administered by infiltration, regional block, or the intravenous route [32–37]. While implementation of multimodal analgesic protocols perioperatively is recommended as an intervention to decrease the prevalence of long-term opioid use following surgery, the concurrent crisis of drug shortages presents an additional challenge. Anaesthesiologists and acute pain medicine specialists will need to advocate locally and nationally to ensure a steady supply of analgesic medications and in-class alternatives for their patients' perioperative pain management.

#### **8. Conclusion**

The recommendations are on the basis of the underlying premise that optimal management begins with the patient assessment and development of a plan of care tailored to the individual and the medical status or the surgical procedure involved, with follow-up assessments and adjustments as needed. The evidences support the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure or the medical condition. Therefore, it is important that clinicians consider their patients' pain in the context of: biological, social and psychological factors.

**253**

**Author details**

1 University of Oradea, Pelican Clinic Hospital, Romania

\*Address all correspondence to: drmob78@yahoo.com

provided the original work is properly cited.

2 Senior Clinical Fellow at St Bartolomew's Hospital, London, UK

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Mihai Botea1,2

*Analgesics*

*DOI: http://dx.doi.org/10.5772/intechopen.94319*

*Pain Management - Practices, Novel Therapies and Bioactives*

prescriptions down to 7.2% in 2015, from 34% in 2012.

or prescribing opioid compounds.

**7. Multimodal analgesia**

tailor to the individual patient.

management.

**8. Conclusion**

patient's pain, limit the number of prescribed opioids analgesics and limit further prescribing by evaluating the patient's pain relief and increased functional ability. The trend to lower usage has had a tremendous impact on opiod use worldwide over the last years. By 2016, paracetamol/hydrocodone, which had been the leading medication prescribed for pain, had dropped from first most prescribed pain medication to the fourth most prescribed drug in the nation, with the volume of

In order to facilitate this continuing trend, it is recommended that the following WHO decision ladder and in-depth patient assessment be utilised before requesting

Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to

Elements of this protocol may include opioids, non-opioid systemic analgesics like paracetamol, non-steroidal anti-inflammatory drugs, gabapentins, ketamine, and local anaesthetics administered by infiltration, regional block, or the intravenous route [32–37]. While implementation of multimodal analgesic protocols perioperatively is recommended as an intervention to decrease the prevalence of long-term opioid use following surgery, the concurrent crisis of drug shortages presents an additional challenge. Anaesthesiologists and acute pain medicine specialists will need to advocate locally and nationally to ensure a steady supply of analgesic medications and in-class alternatives for their patients' perioperative pain

The recommendations are on the basis of the underlying premise that optimal management begins with the patient assessment and development of a plan of care tailored to the individual and the medical status or the surgical procedure involved, with follow-up assessments and adjustments as needed. The evidences support the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure or the medical condition. Therefore, it is important that clinicians consider their patients' pain in the context of: biological, social and psychological

**252**

factors.
