THE NEUROLEPTICS AS ADJUVANT ANALGESICS

The role of neuroleptic drugs as adjuvant analgesics has been a subjec t of longstanding controversy. Despite frequent claims of efficacy, ev idence from controlled trials supports neither claims of intrinsic ana lgesic properties nor the routine use of the neuroleptics as a means t o reliably induce clinically useful analgesia. Methotrimeprazine is un ique in that there is evidence for reliable dose-related analgesia tha t is comparable to opioid-mediated analgesia, although routine use is not recommended. Despite probable interaction with opioid receptors, t here is insufficient evidence to support a role for the butyrophenone category of neuroleptics as adjuvant analgesics. Limited trials of the neuroleptics may be considered for pain that has been unresponsive to more conventional pharmacologic approaches, especially when associate d with headache, nerve injury, or psychological distress. The neurolep tics have an important role in the symptomatic management of agitation , delirium, and nausea, particularly in patients with cancer.