Despite the proven effectiveness of multimodal analgesia in pain management, studies have found that many trauma patients receive intravenous opioids as the sole pain modal­ity, which increases the risk of bothside effects and inade­quate pain control [13]. In major trauma, it is not infrequent for patients to display severe pain that cannot be adequately managed on opioids alone, which can be a clue as to the pres­ence of a neuropathic component, frequently seen in com­plex trauma. Adhering to recommendations from the typical “pain ladder” medications, clinicians may be missing a cru­cial therapeutic target for relief. Beard and Wood published their approach to the complex polytrauma patient used to treat soldiers in Afghanistan [14]. In these cases, a neuro­pathic component is assumed a priori, and anti-neuropathic medication is started early. Specically, anticonvulsants such as gabapentin and pregabalin, tricyclic antidepressant medi­cations (TCA) such as amitriptyline or nortriptyline, and other adjuvants such as IV ketamine [15] and IV lidocaine [16] infusions (in a monitored setting such as ICU), and clonidine or dexmedetomidine which are also commonly used to address sedation and delirium. These medications are started in low doses but are accelerated in the young and oth­erwise healthy patients as the initial phase of shock subsides (See Table37.2). As patients progress in the recovery pro-