Addiction

A chronic neurologic and biologic

disease defined by pain
specialists and characterized by
behaviors that include one or
more of the following: impaired
control over drug use, compulsive
use, continued used despite harm,
and craving to use the opioid for

effects other than pain relief

Adjuvant analgesic agent

A drug that has a primary

indication other than pain
(e.g., anticonvulsant,
antidepressant, sodium
channel blocker, or muscle
relaxant) but is an analgesic
agent for some painful

conditions; sometimes referred

to as co-analgesic

Agonist-antagonist

A type of opioid (e.g., nalbuphine

[Nubain] and butorphanol
[Stadol]) that binds to the kappa
opioid receptor site acting as an
agonist (capable of producing
analgesia) and simultaneously to
the mu opioid receptor site acting
as an antagonist (reversing mu

agonist effects)

Allodynia

Pain due to a stimulus that

does not normally provoke
pain, such as touch; typically
experienced in the skin around
areas affected by nerve injury
and commonly seen with
many neuropathic pain

syndromes

Antagonist

Drug that competes with

agonists for opioid receptor
binding sites; can displace
agonists, thereby inhibiting
their action

Breakthrough pain (BTP)

A transitory increase in pain

that occurs on a background of
otherwise controlled persistent
pain

Ceiling effect

An analgesic dose above

which further dose increments
produce no change in effect

Central sensitization

A key central mechanism of

neuropathic pain; the
abnormal hyperexcitability of
central neurons in the spinal
cord, which results from
complex changes induced by
the incoming barrages of

nociceptors

Comfort-functioning goal

The pain rating identified by

the individual patient above
which the patient experiences
interference with function and
quality of life (e.g., activities
the patient needs or wishes to
perform)

Efficacy

The extent to which a drug or

another treatment works
and can produce the effect in
question analgesia in this
context

Half-life

The time it takes for the plasma

concentration (amount of drug in the
body) to be reduced by 50% (After
starting a drug, or increasing its dose,
four to five half-lives are required to
approacha steady-state level in the
blood, irrespective of the dose, dosing
interval, or route of administration; after
four to five half-lives, a drug that has

been discontinued generally is

considered to be mostly eliminated from
the body.)

Hydrophilic

Readily absorbed in aqueous

solution

Intraspinal

within the spine; refers to

the spaces or potential spaces
surrounding the spinal cord
into which medications can be
administered

Lipophilic

Readily absorbed in fatty

tissues

Metabolite

The product of biochemical

reactions during drug
metabolism

Mu agonist

Any opioid that binds to the

mu opioid receptor subtype
and produces analgesic effects
(e.g., morphine): used
interchangeably with the
terms full agonist, pure
agonist, and morphinelike drug