pain_management:drug_classes []

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== NSAIDs (Most Anti-Inflammatory → Least) ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[cardio:anti_inflammatory:indomethacin|Indomethacin]] | Nociceptive, inflammatory | Acute | Acute gout | Strong anti-inflammatory; higher CNS/GI adverse effects |
| [[cardio:anti_inflammatory:diclofenac|Diclofenac]] | Nociceptive, inflammatory | Acute + Chronic | OA (esp topical) | Higher CV risk; topical less systemic exposure |
| [[cardio:anti_inflammatory:naproxen|Naproxen]] | Nociceptive, inflammatory | Acute + Chronic | OA, tendinitis | Longer duration; GI/renal risk |
| [[cardio:anti_inflammatory:ibuprofen|Ibuprofen]] | Nociceptive (somatic), inflammatory | Acute + Chronic | MSK pain, OA flares | GI/renal risk; ↑BP; ceiling effect |
| [[cardio:anti_inflammatory:celecoxib|Celecoxib]] | Nociceptive, inflammatory | Acute + Chronic | OA/RA, GI-risk patients | COX-2 selective → less GI ulcer risk; still CV/renal risk |

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== Acetaminophen ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[pain_management:acetaminophen|Acetaminophen]] | Nociceptive (mild) | Acute + Chronic | Baseline analgesic, combination therapy | Liver toxicity risk; ceiling effect; safer in CKD than NSAIDs |

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== Corticosteroids (Anti-Inflammatory Strength Similar; Ordered by Clinical Potency) ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[endocrine:dexamethasone|Dexamethasone]] | Inflammatory, cancer-related edema | Acute | Severe inflammation/edema | Most potent per mg; long acting; hyperglycemia, insomnia |
| [[endocrine:methylprednisolone|Methylprednisolone]] | Inflammatory | Acute | Dose packs/flares | Intermediate potency |
| [[endocrine:prednisone|Prednisone]] | Inflammatory pain | Acute (bursts) | Radiculitis flares | Not analgesic; treat inflammation; hyperglycemia, mood, BP |

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== Voltage-Gated Sodium Channel Antagonists ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[pain_management:drugs:suzetrigine|Suzetrigine]] | Nociceptive (acute), mixed | Acute | Oral peripheral analgesia (Nav1.8) | Emerging agent; selective peripheral action |
| [[neuro:local_anesthetics:lidocaine|Lidocaine]] | Neuropathic (localized), procedural | Acute + Chronic | Topical neuropathic pain; procedures | Helpful in PHN; systemic toxicity if misused |

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== Antiepileptics (Neuropathic Pain Efficacy Strength) ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[neuro:carbamazepine|Carbamazepine]] | Neuropathic (paroxysmal) | Chronic | Trigeminal neuralgia | Gold standard TN; hyponatremia; CBC/LFT monitoring |
| [[neuro:pregabalin|Pregabalin]] | Neuropathic, nociplastic | Chronic | DPN, fibromyalgia | Strong evidence; edema; CKD dose adjust |
| [[neuro:gabapentin|Gabapentin]] | Neuropathic | Chronic | DPN, PHN | Sedation; CKD dose adjust |
| [[neuro:oxcarbazepine|Oxcarbazepine]] | Neuropathic | Chronic | Trigeminal neuralgia alt | Hyponatremia |
| [[neuro:lamotrigine|Lamotrigine]] | Neuropathic (selected) | Chronic | Selected cases | Rash/SJS risk |

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== SNRIs (Descending Inhibition Strength) ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[psychiatry:duloxetine|Duloxetine]] | Neuropathic, nociplastic, chronic MSK | Chronic | DPN, fibromyalgia, chronic back pain | Strongest analgesic evidence; nausea; BP monitoring |
| [[psychiatry:venlafaxine|Venlafaxine]] | Neuropathic | Chronic | Neuropathic alternative | Dose-dependent NE effect; withdrawal risk |

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== TCAs (Analgesic Strength > Tolerability) ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[psychiatry:amitriptyline|Amitriptyline]] | Neuropathic, nociplastic | Chronic | Neuropathic pain + sleep | Most potent TCA; anticholinergic; QTc |
| [[psychiatry:nortriptyline|Nortriptyline]] | Neuropathic | Chronic | Better tolerated TCA | Still anticholinergic |

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== NMDA Antagonists ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[neuro:ketamine|Ketamine]] | Hyperalgesia, severe acute pain | Acute | Opioid-refractory pain | Very potent acute analgesic; dissociation; BP elevation |
| [[controlled_substances:methadone|Methadone]] | Mixed, neuropathic component | Chronic | Severe chronic pain | NMDA activity + μ agonist; QTc; complex kinetics |

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== Opioids (Most Potent → Least Potent Relative to Morphine) ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[controlled_substances:fentanyl|Fentanyl]] | Severe nociceptive | Acute | OR/ICU | ~100× morphine potency; patch for opioid-tolerant only |
| [[controlled_substances:buprenorphine|Buprenorphine]] | Mixed | Chronic | Pain + OUD overlap | High receptor affinity; partial agonist; safer respiratory profile |
| [[controlled_substances:methadone|Methadone]] | Mixed, neuropathic component | Chronic | Severe chronic pain | 3–10× morphine; QTc; long half-life |
| [[controlled_substances:oxycodone|Oxycodone]] | Severe nociceptive | Acute + Chronic | Severe acute pain | ~1.5× morphine potency; misuse risk |
| [[controlled_substances:morphine|Morphine]] | Severe nociceptive | Acute + Chronic | Reference opioid | Standard comparator |
| [[controlled_substances:hydrocodone|Hydrocodone]] | Moderate-severe nociceptive | Acute | Short-term acute pain | Often combined with APAP |
| [[controlled_substances:tapentadol|Tapentadol]] | Mixed | Acute/Chronic | Severe pain w/ neuropathic component | μ + NE mechanism; less potent |
| [[controlled_substances:tramadol|Tramadol]] | Mixed | Acute/Chronic | Selected cases | Weakest μ effect; seizure risk; serotonin syndrome |

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== Topical Agents ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[neuro:local_anesthetics:lidocaine|Topical Lidocaine]] | Neuropathic | Chronic | PHN | Strong localized effect |
| [[pain_management:drugs:capsaicin|Capsaicin]] | Neuropathic | Chronic | Peripheral neuropathy | Moderate effect; initial burning |

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== Cannabinoids ==

^ Drug ^ Primary Pain Type(s) ^ Acute vs Chronic ^ Best Clinical Use ^ Key Pearls / Major Cautions ^
| [[pain_management:drugs:thc|THC]] | Neuropathic (modest) | Chronic | Adjunct therapy | Psychoactive; variable response |
| [[pain_management:drugs:cbd|CBD]] | Mixed | Chronic | Adjunct | Limited high-quality evidence |