Beyond Traditional Pain Relief: A Review of Alternative Analgesics in Myocardial Infarction Patient Management

Abstract

While morphine is the recommended first-line treatment for pain management in patients with acute coronary syndrome, recent studies have raised concerns about its association with adverse outcomes. Morphine has been found to cause delayed antiplatelet effects, decreased ticagrelor absorption, increased platelet reactivity, and compromised efficacy of dual antiplatelet therapy (DAPT). Alternative analgesics, such as lidocaine, fentanyl, and acetaminophen, have begun to emerge as viable alternatives, each with unique mechanisms and potential benefits. Lidocaine is demonstrated to have superior effects in reducing microvascular obstruction and fewer adverse events compared to fentanyl, despite being less effective in pain reduction. Fentanyl, which shows rapid onset and powerful analgesic properties, may interfere with ticagrelor absorption, potentially affecting platelet inhibition. Acetaminophen, a centrally acting analgesic, emerges as a safer alternative with comparable pain relief efficacy and minimal side effects. The results of multiple clinical trials emphasize the significance of customizing pain management approaches to match individual patient profiles and achieving the optimal balance between pain relief and potential adverse outcomes.

Keywords:

• Myocardial infarction
• acute coronary syndrome
• lidocaine
• morphine
• fentanyl
• acetaminophen
• trials

Author contributions

NJ and EL conceptualized the present study while SYC and NJ were responsible for methodology and data collection. EL, NJ, SYC, and DSP wrote the initial manuscript while VG verified the data collected and critically revised the manuscript. NJ was responsible for funding while NJ, EL, and VG were responsible for supervision and project administration. All authors have read the final manuscript and agree to publication of the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

No new datasets were generated for the present study.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.