Sherstyuk S. O., Nakonechnа S. А., Zotova A. B., Khramova T. O., Fedorchenko M. O.

PHYSIOLOGICAL MECHANISMS OF PAIN AND PHARMACOLOGICAL METHODS OF ITS RELIEF

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About the author:

Sherstyuk S. O., Nakonechnа S. А., Zotova A. B., Khramova T. O., Fedorchenko M. O.

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LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

Pain is one of the most common and significant symptoms in medicine; its development involves the body’s motor, humoral, and hemodynamic reactions (encompassing nociceptive, neuropathic, and nociplastic pain syndromes). Pain control and suppression are critical aspects of healthcare, aimed at alleviating discomfort and improving people’s quality of life. Pharmacological methods constitute the primary approach to pain management, involving a wide range of medications that act through various mechanisms. The study employed methods of analysis and comparison to examine current scientific research, characterize key pain management techniques, evaluate the sensitivity, specificity, advantages, and disadvantages of each method, and define the role of a comprehensive approach to diagnosing and treating patients with pain syndromes. Based on an analysis of current scientific research, the authors determined that the mechanism of pain onset directly dictates the choice of analgesic agent when formulating a treatment strategy. It has been determined that non-opioid analgesics (ibuprofen, acetylsalicylic acid, diclofenac, paracetamol), steroidal anti-inflammatory drugs (prednisolone, dexamethasone), and opioids (morphine, fentanyl, oxycodone) are appropriate for the treatment of nociceptive pain. First-line agents for treating neuropathic pain syndrome include centrally acting non-opioid analgesics (nefopam) and the antiepileptic drugs gabapentin and pregabalin, with pregabalin demonstrating a stronger and more prolonged effect than gabapentin. However, it was noted that carbamazepine remains the most effective drug for treating trigeminal neuralgia. It was also determined that the use of tricyclic antidepressants (such as clomipramine and amitriptyline), serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine, milnacipran), and gabapentinoids is appropriate for nociplastic pain syndrome.

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Bibliography:

1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. DOI: https://doi.org/10.1097/j.pain.0000000000001939
2. World Health Organization. WHO guideline for the management of chronic pain in adults. Geneva: WHO; 2023.
3. Cohen SP, Vase L, Hooten WM. Chronic pain: An update on burden, best practices and new advances. The Lancet. 2021;397:2082-2097. DOI: https://doi.org/10.1016/s0140-6736(21)00393-7
4. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports. 2022;71(3):1-95. DOI: https://doi.org/10.15585/mmwr.rr7103a1
5. Macintyre PE, Schug SA. Acute Pain Management. 5th ed. Boca Raton: CRC Press; 2021. 338 p. DOI: https://doi.org/10.1201/9780429295058
6. Bannister K, Dickenson AH. What do monoamines do in pain modulation? Current Opinion in Supportive and Palliative Care. 2016;10(2):143-8. DOI: https://doi.org/10.1097/spc.0000000000000207
7. Williams AC, Craig KD. Updating the definition of pain. Pain. 2016;157(11):2420-2423. DOI: https://doi.org/10.1097/j.pain.0000000000000613
8. Kumar KM, Elavarasi P, David CM. Definition of pain and classification of pain disorders. Journal of Advanced Clinical and Research Insights. 2016;3:87-90.
9. Brune K, Patrignani P. New insights into the use of currently available non-steroidal anti-inflammatory drugs. J Pain Res. 2015 Feb 20;8:105-18. DOI: https://doi.org/10.2147/jpr.s75160
10. Moore RA, Derry S, Aldington D, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;2015(9):CD008659. DOI: https://doi.org/10.1002/14651858.cd008659.pub3
11. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-73. DOI: https://doi.org/10.1016/s1474-4422(14)70251-0
12. Katzung BG. Basic & Clinical Pharmacology. 16th ed. McGraw-Hill; 2024. 1361 p. https://accessmedicine.mhmedical.com/book. aspx?bookID=3382
13. Eccleston C, Fisher E, Cooper TE, Grégoire MC, Heathcote LC, Krane E, et al. Pharmacological interventions for chronic pain in children: an overview of systematic reviews. Pain. 2019;160(8):1698-1707. DOI: https://doi.org/10.1097/j.pain.0000000000001609
14. Strand N, J M, Tieppo Francio V, M M, Turkiewicz M, El Helou A, et al. Advances in Pain Medicine: a Review of New Technologies. Curr Pain Headache Rep. 2022;26(8):605-616. DOI: https://doi.org/10.1007/s11916-022-01062-6
15. Benzon H, Raja SN, Cohen SP, Bhatia A, Nelson AM, Shanthanna H. Essentials of Pain Medicine. 5th ed. Elsevier; 2026. 880 p.
16. Kupko. Model poetapnoho likuvannia patsiientiv iz notsytseptyvnym bolem. Neironews: psykhonevrolohiia i neiropsykhiatriia. 2025;5(160):38-42. [in Ukrainian].
17. Pergolizzi JV Jr, Raffa RB, Rosenblatt MH. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. J Clin Pharm Ther. 2020;45(5):892-903. DOI: https://doi.org/10.1111/jcpt.13114
18. Kianian S, Bansal J, Lee C, Zhang K, Bergese SD. Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options. APS. 2024;2:9. DOI: https://doi.org/10.1007/s44254-023-00043-1
19. van Eijk LT, van den Heuvel SAS, van Boekel RLM, van der Meer R, Bruhn J, Wever KE. The effect of adding a second multimodal analgesic component to anesthesia regimens on acute postoperative pain outcomes: a systematic review and meta-analysis. BMC Anesthesiol. 2026;26(1):225. DOI: https://doi.org/10.1186/s12871-026-03714-1
20. Joshi GP. Rational Multimodal Analgesia for Perioperative Pain Management. Curr Pain Headache Rep. 2023;27(8):227-237. DOI: https://doi.org/10.1007/s11916-023-01137-y
21. Kummer I, Lüthi A, Klingler G, Andereggen L, Urman RD, Luedi MM, et al. Adjuvant Analgesics in Acute Pain – Evaluation of Efficacy. Curr Pain Headache Rep. 2024;28(9):843-852. DOI: https://doi.org/10.1007/s11916-024-01276-w
22. Finnerup NB, Kuner R, Jensen TS. Neuropathic Pain: From Mechanisms to Treatment. Physiol Rev. 2021;101(1):259-301. DOI: https://doi.org/10.1152/physrev.00045.2019
23. Mojica JJ, Eddy G, Schwenk ES. N-Methyl-D-aspartate receptor antagonists for the prevention of chronic postsurgical pain: a narrative review. Reg Anesth Pain Med. 2025;50(2):160-167. DOI: https://doi.org/10.1136/rapm-2024-105612
24. Reinert JP, Veronin MA, Medina C. Tricyclic Antidepressants in Nociceptive and Neuropathic Pain: A Review of Their Analgesic Properties in Combination With Opioids. J Pharm Technol. 2023;39(1):35-40. DOI: https://doi.org/10.1177/87551225221139699
25. Ferreira GE, Abdel-Shaheed C, Underwood M, Finnerup NB, Day RO, McLachlan A, et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. BMJ. 2023;380:e072415. DOI: https://doi.org/10.1136/bmj-2022-072415
26. Sills GJ, Rogawski MA. Mechanisms of Action of Currently Used Antiseizure Drugs. Neuropharmacology. 2020;168:107966. DOI: https://doi.org/10.1016/j.neuropharm.2020.107966
27. Gropper MA, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Leslie K, editors. Miller’s anesthesia. 9th ed. Philadelphia: Elsevier; 2020. Chapter 45, Spinal, epidural, and caudal anesthesia; p. 1684-1720.
28. Redaktsiia zhurnalu Ukrainskyi medychnyi chasopys. Antahonisty CGRP pry mihreni: vid patofiziolohii do likuvannia. Ukr. med. chasopys. 2023;5(157):2-8. DOI: https://doi.org/10.32471/umj.1680-3051.157.248323 [in Ukrainian].
29. Gordon EA, Tyagi S, Dib-Hajj SD, Bennett DL. Selective targeting of voltage-gated sodium channels to achieve analgesia: current status and future directions. Pain. 2025;166(11S):S42-S46. DOI: https://doi.org/10.1097/j.pain.0000000000003639
30. Rauwerdink A, Spinazze P, Gijsbers H, Molendijk J, Zwolsman S, Schijven MP, et al. Approaches to Evaluating Digital Health Technologies: Scoping Review. J Med Internet Res. 2024;26:e50251. DOI: https://doi.org/10.2196/50251

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 149-154 pages, index UDC 616.8-009.7-085.212

DOI:

10.29254/2077-4214-2026-3-182-149-154