The Emerging Role of NMDA Antagonists in Pain Management

Dana Jamero, PharmD, BCOP; Amne Borghol, PharmD; Nina Vo, PharmD Candidate; Fadi Hawawini, DO


US Pharmacist 

In This Article

Opioid Resistance and Neuropathic Pain

Opioid resistance is defined as unresponsiveness to IV morphine sulfate of at least 100 mg per hour (or equivalent dosing of another opioid), consistently high pain ratings, and unrelieved pain even after the opioid dose is doubled. Opioid resistance has been found in a multitude of disease states including cancer, chronic pain, neuropathy, complex regional pain syndrome, postherpetic neuralgia, and pancreatitis.[6]Neuropathic pain results from injury to peripheral or central nerves and is commonly treated with agents such as TCAs and anticonvulsants. Unfortunately, a majority of patients do not experience significant relief with these agents.[7,8] In both opioid resistance and neuropathic pain, N-methyl-daspartate (NMDA) antagonists may be an option.


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