The Concept of Multimodal Analgesia
Feb 24, 2025
The multimodal approach - key recommendations for effective pain management
The term multimodal is often thrown around when discussing analgesia, but what does it actually mean? ๐ค
Essentially, multimodal refers to the use of multiple classes of analgesic agents ๐ that target different receptors throughout pain pathways ๐ง . The goal of this is to effectively manage pain ๐ฉน while limiting side effects from individual classes of drugs ๐.
A classic, basic example that is common in the perioperative setting ๐ฅ, is the use of opioid medications ๐ for pain management. Side effects of opioids include constipation ๐ฉ, nausea ๐คข and vomiting ๐คฎ, respiratory depression ๐ค and sedation ๐ด - all of which we want to avoid for our patients! In an effort to do this, administration of agents such as paracetamol ๐, non-steroidal anti-inflammatory agents ๐ฅ and local anaesthetic agents ๐ can help to reduce the overall amount of opioid required to adequately manage pain, reducing the occurrence or severity of opioid-related side effects ๐.
A multimodal approach should be thought of as a recipe ๐ณ for pain management, incorporating recommended drug classes ๐ with individual drug selections made (or omitted) based on the patient's history ๐งโ๏ธ. The approach should aim to include the following elements (where possible):
๐ Simple analgesia (paracetamol and NSAIDS)
๐ Local anaesthetic
๐ Opioid analgesia
๐ซ Opioid sparing adjuncts
Each patient presents with their own unique pain experience ๐ and history, meaning that multimodal analgesia will look different for each patient ๐งโ๏ธ. Some factors that will influence analgesia options and decisions include:
โ ๏ธ Drug allergies ๐พ
๐ Drug interactions from regular medications ๐งโ๏ธ
๐ถ Age ๐ง
๐ด Respiratory conditions (eg sleep apnoea ๐๏ธ)
๐ง Kidney/Liver function ๐งฌ
โ๏ธ Chronic/persistent pain ๐
๐ Opioid tolerance and/or substance use disorder ๐๏ธ
๐ง Cognition ๐งฉ
Build Knowledgeโ
Improve Safetyโ
References:
ANZCA (2023) PS41 - Position statement on acute pain management. https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management
Schwenk, E. S., & Mariano, E. R. (2018). Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean journal of anesthesiology, 71(5), 345–352. https://doi.org/10.4097/kja.d.18.00217
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