Masui. The Japanese journal of anesthesiology
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Chronic intractable pain is well known to be very difficult in management. The mechanisms of intractable chronic pain are complicated. Therefore, such a patient is often involved with multiple pain mechanisms and needs multiple drugs which have different types of analgesic actions. ⋯ Therefore, the evaluation of many factors which modulate the pain behavior is important. Opioids such as morphine and other analgesics are sometimes useful for the treatment of chronic intractable pain. Nerve blocks and interventional treatments are also helpful.
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Adjuvant analgesics including antidepressant and anticonvulsant are highly useful toward intractable chronic pains, especially neuropathic pain. In recent years, selection of the first line treatment is done by balancing between efficacies of candidate drugs and their potential adverse effects. While evaluating the efficacy of a drug is easy when it is used alone; however, it may not be always so if multiple drugs are used concurrently.