The Concept of Multimodal Analgesia

analgesia opioids pain 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? ๐Ÿค”

Essentially, multimodal refers to the use of multiple classes of analgesic agents ๐Ÿ’Š that target different receptors throughout pain pathways ๐Ÿง . The goal of this is to effectively manage pain ๐Ÿฉน while limiting side effects from individual classes of drugs ๐Ÿ›‘.

A classic, basic example that is common in the perioperative setting ๐Ÿฅ, is the use of opioid medications ๐Ÿ’‰ for pain management. Side effects of opioids include constipation ๐Ÿ’ฉ, nausea ๐Ÿคข and vomiting ๐Ÿคฎ, respiratory depression ๐Ÿ˜ค and sedation ๐Ÿ˜ด - all of which we want to avoid for our patients! In an effort to do this, administration of agents such as paracetamol ๐Ÿ’Š, non-steroidal anti-inflammatory agents ๐Ÿ’ฅ and local anaesthetic agents ๐Ÿ’‰ can help to reduce the overall amount of opioid required to adequately manage pain, reducing the occurrence or severity of opioid-related side effects ๐Ÿ›‘.

A multimodal approach should be thought of as a recipe ๐Ÿณ for pain management, incorporating recommended drug classes ๐Ÿ’Š with individual drug selections made (or omitted) based on the patient's history ๐Ÿง‘‍โš•๏ธ. The approach should aim to include the following elements (where possible):

๐Ÿ’Š Simple analgesia (paracetamol and NSAIDS)

๐Ÿ’‰ Local anaesthetic

๐Ÿ’€ Opioid analgesia

๐Ÿšซ Opioid sparing adjuncts

Each patient presents with their own unique pain experience ๐Ÿ˜– and history, meaning that multimodal analgesia will look different for each patient ๐Ÿง‘‍โš•๏ธ. Some factors that will influence analgesia options and decisions include:

โš ๏ธ Drug allergies ๐ŸŒพ

๐Ÿ’Š Drug interactions from regular medications ๐Ÿง‘‍โš•๏ธ

๐Ÿ‘ถ Age ๐Ÿง’

๐Ÿ˜ด Respiratory conditions (eg sleep apnoea ๐Ÿ›๏ธ)

๐Ÿง Kidney/Liver function ๐Ÿงฌ

โš–๏ธ Chronic/persistent pain ๐Ÿ’”

๐Ÿ’‰ Opioid tolerance and/or substance use disorder ๐Ÿš๏ธ

๐Ÿง  Cognition ๐Ÿงฉ

Build Knowledgeโœ…
Improve Safetyโœ…

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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