Psychostimulants

Psychostimulant medications are believed to have antinociceptive properties that may be mediated by norepinephrine, serotonin, or dopamine or by endogenous opioid mechanisms. Indications for psychostimulants include reduction of drowsiness caused by narcotic medications as well as the potential to reduce the dose of narcotics without diminution of their analgesic effect. Methylphenidate and dextroamphetamine have been found to be safe and effective adjuncts to opiate analgesia and have also been used in the treatment of spasmodic torticollis, spastic colon, and headaches.

Potentiation of analgesia by sympathomimetics has been well described. Caffeine is known to increase the analgesic effects of aspirin and acetaminophen, and one study suggested that dextroamphet-amine doubled the analgesic potency of morphine (Forrest et al. 1977). The long-term use of these stimulants in pain has not been systematically evaluated. The use of these drugs should probably be limited to a therapeutic trial period of several days to determine efficacy for individual patients.

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