Analgesic combinations as a strategy for pain relief and isobolographic analysis

  • Aracely Evangelina Chávez-Piña Instituto Politécnico Nacional
  • Arlette Guadalupe Arroyo-Lira Instituto Politécnico Nacional
Keywords: analgesic, combination, interaction, isobolographic analysis, nsaids, opioids

Abstract

Pain is a multidimensional sensory experience that is intrinsically unpleasant and associated with hurting and soreness, it is essentially a sensation. Pain has strong, cognitive and emotional components, it is linked to, or described in terms of suffering. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and opioid analgesics are two of the most common types of drugs used for pain management. However, the use of these analgesics is limited by the presence of significant adverse effects. A useful practice is a combination of two agents with the same therapeutic effect wherein each agent is administered to obtain additive, synergistic or subadditive interaction in a fixed ratio. If the combination resulted in addition or synergism, the doses employed by each agent are reduced, then the side effects are absent; this kind of study is named isobolographic analysis. In this review, the authors summarized previous reports of the combination of NSAIDs with opioids and natural products as an alternative in the pain management.

References

1. Straube A, Aicher B, Fiebich BL, et al. Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics? BMC Neurol. 2011;11:43.

2. Ossipov MH. The perception and endogenous modulation of pain. Scientifica (Cairo). 2012;2012:561761.

3. Puebla Diaz F. Tipos de dolor y escala terapéutica de la O.M.S.: Dolor iatrogénico. Oncología Radioterápica. 2005;28(3):5.

4. Parsadaniantz SM, Rivat C, Rostene W, et al. Opioid and chemokine receptor crosstalk: a promising target for pain therapy? Nat Rev Neurosci. 2015;16(2):69-78.

5. Ortiz MI, Molina MA, Arai YC, et al. Analgesic drugs combinations in the treatment of different types of pain. Pain Res Treat. 2012;2012:612519.

6. Fornasari D. Pain mechanisms in patients with chronic pain. Clin Drug Investig. 2012;32 Suppl 1:45-52.

7. Souza MH, Mota JM, Oliveira RB, et al. Gastric damage induced by different doses of indomethacin in rats is variably affected by inhibiting iNOS or leukocyte infiltration. Inflamm Res. 2008;57(1):28-33.

8. Johnson Q, Borsheski RR, Reeves-Viets JL. Pain management mini-series. Part I. A review of management of acute pain. Mo Med. 2013;110(1):74-79.

9. Miranda HF, Puig MM, Prieto JC, et al. Synergism between paracetamol and nonsteroidal anti-inflammatory drugs in experimental acute pain. Pain. 2006;121(1-2):22-28.

10. Focus on pain. Nat Neurosci. 2014;17(2):145.

11. Ortiz MI, Ramirez-Montiel ML, Gonzalez-Garcia MP, et al. The combination of naproxen and citral reduces nociception and gastric damage in rats. Arch Pharm Res. 2010;33(10):1691-1697.

12. Raffa RB, Pergolizzi JV, Jr., Tallarida RJ. The determination and application of fixed-dose analgesic combinations for treating multimodal pain. J Pain. 2010;11(8):701-709.

13. WHO | WHO's cancer pain ladder for adults Available: http://www.who.int/cancer/palliative/painladder/en/. Accessed April 13, 2015.

14. Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55(3):377-391.

15. Curatolo M, Sveticic G. Drug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination. Best Pract Res Clin Anaesthesiol. 2002;16(4):507-519.

16. Stone LS, German JP, Kitto KF, et al. Morphine and clonidine combination therapy improves therapeutic window in mice: synergy in antinociceptive but not in sedative or cardiovascular effects. PLoS One. 2014;9(10):e109903.

17. Chavarria-Bolanos D, Perez-Urizar J, Grandfils C, et al. Peripheral synergism between tramadol and ibuprofen in the formalin test. Drug Dev Res. 2014;75(4):224-230.

18. Deciga-Campos M, Cortes A, Pellicer F, et al. Isobolographic analysis of the antinociceptive interaction between ursolic acid and diclofenac or tramadol in mice. Planta Med. 2014;80(2-3):139-145.

19. Garcia-Hernandez L, Deciga-Campos M, Guevara-Lopez U, et al. Co-administration of rofecoxib and tramadol results in additive or sub-additive interaction during arthritic nociception in rat. Pharmacol Biochem Behav. 2007;87(3):331-340.

20. Janovsky M, Krsiak M. Codeine did not increase analgesic efficacy of coxibs in contrast to that of paracetamol or ibuprofen: isobolographic analysis in mice. Neuro Endocrinol Lett. 2011;32(2):164-169.

21. Tallarida RJ, Cowan A, Raffa RB. Antinociceptive synergy, additivity, and subadditivity with combinations of oral glucosamine plus nonopioid analgesics in mice. J Pharmacol Exp Ther. 2003;307(2):699-704.

22. Maroon JC, Bost JW, Maroon A. Natural anti-inflammatory agents for pain relief. Surg Neurol Int. 2010;1:80.

23. Caughey GE, James MJ, Proudman SM, et al. Fish oil supplementation increases the cyclooxygenase inhibitory activity of paracetamol in rheumatoid arthritis patients. Complement Ther Med. 2010;18(3-4):171-174.

24. Acosta M, II, Castaneda-Hernandez G, Cilia-Lopez VG, et al. Interaction between Heliopsis longipes extract and diclofenac on the thermal hyperalgesia test. Phytomedicine. 2009;16(4):336-341.

25. Mansouri MT, Naghizadeh B, Ghorbanzadeh B. Ellagic acid enhances the antinociceptive action of venlafaxine in mouse acetic acid-induced pain: An isobolographic analysis. Pharmacol Rep. 2015;67(3):473-477.

26. Naghizadeh B, Mansouri MT, Ghorbanzadeh B. Ellagic acid enhances the antinociceptive action of carbamazepine in the acetic acid writhing test with mice. Pharm Biol. 2015:1-5.

27. Montiel-Ruiz RM, Gonzalez-Trujano ME, Deciga-Campos M. Synergistic interactions between the antinociceptive effect of Rhodiola rosea extract and B vitamins in the mouse formalin test. Phytomedicine. 2013;20(14):1280-1287.

28. Arroyo-Lira AG, Rodriguez-Ramos F, Chavez-Pina AE. Synergistic antinociceptive effect and gastric safety of the combination of docosahexaenoic acid and indomethacin in rats. Pharmacol Biochem Behav. 2014;122:74-81.

29. Tallarida RJ. Interactions between drugs and occupied receptors. Pharmacol Ther. 2007;113(1):197-209.

30. Pleuvry BJ. Pharmacodynamic and pharmacokinetic drug interactions. Anaesthesia & Intensive Care Medicine. 2005;6(4):129-133.

31. Tallarida RJ. Quantitative methods for assessing drug synergism. Genes Cancer. 2011;2(11):1003-1008.

32. Zhao L, Au JL, Wientjes MG. Comparison of methods for evaluating drug-drug interaction. Front Biosci (Elite Ed). 2010;2:241-249.

33. Tallarida RJ. Drug synergism: its detection and applications. J Pharmacol Exp Ther. 2001;298(3):865-872.

34. Tallarida RJ. An overview of drug combination analysis with isobolograms. J Pharmacol Exp Ther. 2006;319(1):1-7.

35. Tallarida RJ. Revisiting the isobole and related quantitative methods for assessing drug synergism. J Pharmacol Exp Ther. 2012;342(1):2-8.

36. Hurley RW, Chatterjea D, Rose Feng M, et al. Gabapentin and pregabalin can interact synergistically with naproxen to produce antihyperalgesia. Anesthesiology. 2002;97(5):1263-1273.

37. Tallarida RJ. The interaction index: a measure of drug synergism. Pain. 2002;98(1-2):163-168.

38. Satyanarayana PS, Jain NK, Singh A, et al. Isobolographic analysis of interaction between cyclooxygenase inhibitors and tramadol in acetic acid-induced writhing in mice. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(4):641-649.

39. Miranda HF, Pinardi G. Isobolographic analysis of the antinociceptive interactions of clonidine with nonsteroidal anti-inflammatory drugs. Pharmacol Res. 2004;50(3):273-278.

40. Miranda HF, Prieto JC, Pinardi G. Spinal synergy between nonselective cyclooxygenase inhibitors and morphine antinociception in mice. Brain Res. 2005;1049(2):165-170.

41. Van Elstraete AC, Sitbon P, Benhamou D, et al. The median effective dose of ketamine and gabapentin in opioid-induced hyperalgesia in rats: an isobolographic analysis of their interaction. Anesth Analg. 2011;113(3):634-640.

42. Tomic MA, Vuckovic SM, Stepanovic-Petrovic RM, et al. Synergistic interactions between paracetamol and oxcarbazepine in somatic and visceral pain models in rodents. Anesth Analg. 2010;110(4):1198-1205.

43. Yoon MH, Park KD, Lee HG, et al. Additive antinociception between intrathecal sildenafil and morphine in the rat formalin test. J Korean Med Sci. 2008;23(6):1033-1038.

44. Luszczki JJ, Kolacz A, Czuczwar M, et al. Synergistic interaction of gabapentin with tiagabine in the formalin test in mice: an isobolographic analysis. Eur J Pain. 2009;13(7):665-672.

45. Dudhgaonkar SP, Tandan SK, Kumar D, et al. Synergistic interaction between meloxicam and aminoguanidine in formalin-induced nociception in mice. Eur J Pain. 2008;12(3):321-328.
Published
2015-07-05