Analgesic Pharmacotherapy

Pharmacotherapy at Bolest Brno means individually tailored analgesic prescribing guided by an expert in pain medicine — not a GP applying a standard ladder. MUDr. Hakl and the team use all drug categories and delivery forms, including transdermal patches, to build a personalised analgesic regimen that maximises pain control while minimising adverse effects. The clinic's philosophy is explicit: use the drug combination that gives the most benefit with the least side-effect burden. This may involve standard analgesics, adjuvant drugs (anticonvulsants, antidepressants used for their analgesic properties), muscle relaxants, topical agents and opioids when clinically indicated. Treatment is reviewed at every visit to adjust dosing, switch agents if tolerance or adverse effects develop, and integrate pharmacotherapy with non-drug interventions.

Pharmacotherapy is the foundation of evidence-based pain medicine — and at Bolest Brno, it is delivered with specialist-level depth that distinguishes the clinic from general practice or basic pain management. MUDr. Marek Hakl, PhD., holds certification in Palliative Medicine and Pain Management in addition to his algeziology qualification, and has authored four clinical monographs; the pharmacological management of complex pain is a core part of his academic and clinical portfolio. **The analgesic approach:** The World Health Organization's analgesic ladder and the IASP's evidence-based guidelines provide the framework, but actual prescribing at Bolest Brno goes considerably further: - **Non-opioid analgesics:** Paracetamol, NSAIDs (COX-1 and COX-2 selective), metamizole — first-line and as adjuncts, selected for their safety profile in each patient - **Adjuvant analgesics:** Anticonvulsants (gabapentin, pregabalin) for neuropathic pain; tricyclic and SNRI antidepressants (amitriptyline, duloxetine) used specifically for their analgesic properties in central sensitisation and neuropathic conditions; muscle relaxants for spasm-mediated pain - **Topical agents:** Lidocaine patches, diclofenac gel, capsaicin preparations — particularly valuable for localised pain in patients with high systemic drug burden - **Transdermal opioids:** Fentanyl and buprenorphine patches for controlled, continuous analgesic delivery in chronic pain where oral opioids produce problematic peaks and troughs - **Opioid rotation:** When one opioid produces intolerable adverse effects, the team employs equianalgesic dose rotation to an alternative agent **Combination rationale:** Effective pain management often requires combining drugs that act on different mechanisms simultaneously — e.g., an NSAID for peripheral inflammation, a gabapentinoid for central sensitisation, and a muscle relaxant for spasm. The clinic designs these combinations individually, taking into account each patient's comorbidities, other medications (drug interaction screening), renal and hepatic function, and preferences. **Philosophy on adverse effects:** The clinic explicitly states that minimum adverse effects are the primary selection criterion when two analgesic options offer similar efficacy. This drives choices such as preferring transdermal delivery (avoids hepatic first-pass, stable plasma levels) over oral opioids in certain patients, or selecting a COX-2 selective NSAID over a non-selective one in patients with gastric risk. **Patient education and self-management:** The pharmacotherapy consultation includes explanation of how each drug works, what side effects to watch for, and how to manage breakthrough pain. Patients leave with a clear written plan and direct phone access to the prescribing physician. **Integration with other modalities:** At Bolest Brno, pharmacotherapy is almost always combined with non-pharmacological interventions — TENS, acupuncture, nerve blocks or injections — because the evidence consistently shows that multimodal pain management outperforms any single modality. The physician reviews the combined plan at each follow-up and adjusts it based on clinical response.