Adjuvant drugs are not true pain relief medications, but they are used in the management of pain conditions that are otherwise difficult to treat. Usually, adjuvant drugs are used to enhance the pain relief provided by the commonly used pain medicines. However, they may also be prescribed on their own without other pain relievers. Adjuvant drugs are most often used for neuropathic and other chronic pain problems. There are several different types of adjuvant drugs including antidepressants, anticonvulsants, corticosteroids, sedatives, and muscle relaxants.
Tricyclic anti-depressants
Tricyclic anti-depressants (TCAs), as their name suggests, were first developed to treat depression. However, it has been discovered that they can be helpful in treating neuropathic pain. When used for this purpose, much smaller doses are given than for depression.
TCAs can cause side effects. These include dry mouth, constipation, sleepiness, and, very rarely, heart beat changes. Such effects are usually not troublesome and tend to subside after a few days. Your doctor may ask you to have an electrocardiogram (ECG) before starting a TCA.
Anticonvulsants
Anticonvulsants were first developed to treat seizures. However, they are also used to treat neuropathic pain because they have a calming effect on pain nerves that are overactive.
A commonly prescribed anticonvulsant is gabapentin. Gabapentin is usually well tolerated but can cause some side effects including drowsiness, dizziness, fatigue, and reduced concentration. These side effects can be minimized by increasing the dose slowly and usually subside within a few days.
Corticosteroids
Corticosteroids are anti-inflammatory drugs that can be used to relieve severe pain associated with nerve irritation and inflammation. They may be taken orally or injected directly into the areas of the body where there is pain. Corticosteroids are often used only for a short period of time because of their side effects. These include weight gain, poor growth, and suppression of certain hormones.
Muscle relaxants
Sometimes muscle relaxants will be prescribed to help relax muscles as a way of easing pain. Commonly used muscle relaxants are methocarbamol, baclofen and benzodiazepines. Some of these medicines can be purchased at the drug store without a prescription, while others will require a prescription. These medicines may make your child sleepy.
Sedatives
Children sometimes need to lie still for diagnostic or treatment procedures. It may be necessary to sedate your child depending on the procedure and your child’s response to calming and pain reducing strategies, such as distraction. In general, sedation is a drug-induced state of reduced consciousness that can, but does not necessarily, put your child to sleep. Sedation is not intended to provide pain relief. The medicines used to sedate patients produce a reduced level of, or a complete loss of, consciousness.
Minimal (or mild) sedation can be achieved by using medicines such as midazolam (Versed), diazepam (Valium), or lorazepam (Ativan). Children in this state can still speak and respond to questions. Higher brain functions such as thinking are impaired, but basic bodily functions, such as breathing and the pumping action of the heart, are unaffected. Minimal sedation is generally used for procedural pain, such as for the removal of dressings. It might also be used to ensure that children remain still during MRIs or CT scans.
Moderate sedation brings about a slightly deeper state of sleep. Your child will retain most of the characteristics of minimal sedation, but they will have more trouble answering questions and following instructions. Moderate sedation might be used to perform a spinal tap or to change a burn dressing.
Deep sedation produces a loss of consciousness. Although your child is asleep under deep sedation, they will still respond in a physical way to pain. Some of the medicines used to provide deep sedation in children include chloral hydrate and pentobarbital. These medicines are used for procedures involving young children when they are required to be asleep in order to remain very still.
In the case of general anaesthesia, the deepest form of sedation, your child will be completely unconscious, will not respond to pain, and may require assistance with breathing. General anaesthesia is used for surgical procedures. A specially trained doctor called an anaesthetist will provide general anaesthesia for your child.
Sedation can produce adverse reactions. Certain precautions will be taken to minimize risks. Your child will be assessed before undergoing sedation, and may not be allowed to eat or drink for several hours before the procedure. Your child will be monitored continuously during sedation.