Pakistan Journal of Pharmaceutical Sciences

Abstract: Background: Chronic non-cancer pain (CNCP) is highly prevalent and often requires analgesic combination therapy due to its complex mechanisms. However, real-world evidence on how different combination regimens correlate with pain relief and treatment modification remains limited, which hampers optimal multimodal analgesia selection. Objectives: To explore real world analgesic combination patterns in CNCP, analyze their associations with pain intensity changes and regimen adjustments and provide evidence for individualized multimodal analgesia. Methods: This retrospective study included 120 CNCP patients (Jan 2022 to Jan 2024) categorized into three regimens: Dual (NSAIDs?+?acetaminophen, n=42), Opioid (weak opioid?+?adjuvant, n=38) and Triple (NSAIDs?+?opioid?+?adjuvant, n=40). Numerical Rating Scale (NRS) scores, therapy duration, regimen adjustments and adverse reactions were extracted. Multiple linear regression and binary logistic regression were used to identify factors associated with pain relief and treatment modification. Results: The Triple group achieved the highest pain-relief rate (77.5%) compared with the Opioid (63.2%) and Dual (50.0%) groups (P<0.05). The treatment modification rate was highest in the Dual group (45.2%, mainly escalation; P<0.05). Adverse reactions were more frequent in the Triple group than in the Dual group (P<0.05), but no serious events occurred. Regression analyses identified Triple therapy (B=0.455, 95% CI: 0.260–0.649, P<0.001) and baseline NRS (B=0.607, 95% CI: 0.491–0.723, P<0.001) as independent factors for greater pain relief. Triple therapy (OR=0.256, 95% CI: 0.090–0.729, P=0.011) and longer baseline pain duration (OR=0.917, 95% CI: 0.860–0.978, P=0.009) were independent protective factors against treatment modification. Conclusion: CNCP patients exhibit distinct patterns of analgesic combination. Triple therapy was associated with better pain relief persistence and fewer adjustments but higher adverse reaction risks. Therapy selection should be stratified by pain phenotype and patients with moderate to severe pain may benefit from early standardized combination therapy, which was linked to fewer subsequent regimen adjustments.