Combination drug therapy for chronic pain: a call for more clinical studies.
Chronic pain is a debilitating clinical condition associated with a variety of disease entities including diabetic neuropathy, postherpetic neuralgia, low back pathology, fibromyalgia, and neurological disorders. For many general practitioners and specialists, managing chronic pain has become a daunting challenge. As a modality of multidisciplinary chronic pain management, medications are often prescribed in combinations, an approach referred to as combination drug therapy (CDT). However, many medications for pain therapy, including antidepressants and opioid analgesics, have significant side effects that can compound when used in combination and impact the effectiveness of CDT. To date, clinical practice of CDT for chronic pain has been based largely on clinical experiences. In this article, we will focus on (1) the scientific basis and rationales for CDT, (2) current clinical data on CDT, and (3) the need for more clinical studies to establish a framework for the use of CDT.


CONCLUSIONS
More preclinical, clinical, and translational studies are needed to improve the efficacy of combination drug therapy that is an integral part of a comprehensive approach to the management of chronic pain.
Mao
Jianren
J
MGHCenter for Translational Pain Research, Department of Anesthesia, Harvard Medical School, Boston, MA 02114, USA. jmao@partners.org
Gold
Michael S
MS
Backonja
Miroslav Misha
MM
D000698:Analgesia / Q000379:methods* / Q000639:trends; D000700:Analgesics / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000592:standards / Q000639:trends; D004359:Drug Therapy, Combination / Q000379:methods* / Q000639:trends; D006801:Humans; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology
D000700:Analgesics