[Drug interactions in pain therapy]

Schmerz. 2015 Dec;29(6):595-603. doi: 10.1007/s00482-015-0017-1.
[Article in German]


Background: Pain is one of the most common reasons for consulting a physician. Chronic pain patients often suffer from a variety of comorbidities, such as depression and anxiety and they are therefore often simultaneously treated with more than one drug. The probability of drug interactions increases with every additional drug.

Material and methods: A systematic internet and literature search up to February 2015 was carried out. Systematic lists were included. In addition, the drug prescription information sheets were used and an internet search via Pubmed and google.com was carried out for drugs alone and in combination in order to find substance-specific interactions.

Results: A differentiation is made between pharmaceutical, pharmacodynamic and pharmacokinetic drug interactions. Pharmaceutical interactions are caused by chemical, physical or physicochemical incompatibility of drugs or adjuvants used. These can even occur outside the body and during concomitant administration via the same route. A pharmacodynamic interaction in pain management is for example the additive sedative effect of opioids and benzodiazepines when taken together. Pharmacokinetic interactions occur during the absorption, distribution, metabolism and in the elimination phases.

Conclusion: Many drug interactions can be avoided by careful and continuous evaluation of pharmacotherapy and if necessary its adaptation; however, a sound knowledge of the underlying pharmacological mechanisms and the properties of currently used analgesics is necessary.

Keywords: Adjuvants; Administration; Drugs; Pharmacodynamics; Pharmacokinetics.

Publication types

  • Review

MeSH terms

  • Analgesics / adverse effects*
  • Analgesics / pharmacokinetics
  • Analgesics / therapeutic use
  • Chronic Pain / blood
  • Chronic Pain / drug therapy*
  • Comorbidity
  • Drug Interactions*
  • Drug Therapy, Combination
  • Humans


  • Analgesics