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Antidepressants in Pain Management

  • Kris Ferguson
  • Nicole Wolfgram
Chapter

Abstract

Patients with chronic pain often have several pain generators, and therefore, the treatment of their pain requires a multifaceted approach. One resource used by providers is the use of antidepressant medications. There are three classes of antidepressants which include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and selective norepinephrine reuptake inhibitors (SNRIs). Multiple studies have shown the TCAs to be multipurpose, nonspecific analgesic adjuncts. SSRIs are typically less effective in pain than TCAs but their use can be beneficial, particularly when the use of TCAs is contraindicated or not well tolerated due to side effects. The SNRI duloxetine is the first antidepressant in the USA to have a specific indication for use in pain management.

Keywords

Antidepressants Tricyclic antidepressants (TCA) Serotonin-norepinephrine reuptake inhibitors (SNRI) Selective serotonin reuptake inhibitors (SSRI) Neuropathy Fibromyalgia 

Recommended Reading

  1. 1.
    Argoff C, McCleane G. Pain management secrets. Philadelphia: Mosby/Elsevier; 2009.Google Scholar
  2. 2.
    Argoff C, Albrecht P, Irving G, Rice F. Multimodal analgesia for chronic pain: rationale and future directions. Pain Med. 2009;10(suppl 2):S53–66.CrossRefGoogle Scholar
  3. 3.
    Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain. Pain. 2015;156:S104–14.CrossRefGoogle Scholar
  4. 4.
    Finnerup N, Attal N, Haroutounian S. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet. 2015;14(2):162–73.CrossRefGoogle Scholar
  5. 5.
    Griebeler M, Morey-Vargas O, Brito J, Tsapas A, Wang Z, Carranza Leon B, et al. Pharmacologic interventions for painful diabetic neuropathy. Ann Intern Med. 2014;161(9):639.CrossRefGoogle Scholar
  6. 6.
    Hearn L, Derry S, Phillips T, Moore R, Wiffen P. Imipramine for neuropathic pain in adults. Cochrane Database Syst Rev. 2014;5:CD010769.Google Scholar
  7. 7.
    Julien R. A primer of drug action. New York: Henry Holt and Company; 2013.Google Scholar
  8. 8.
    Lipkovich I, Choy E, Van Wambeke P, Deberdt W, Sagman D. Typology of patients with fibromyalgia: cluster analysis of duloxetine study patients. BMC Musculoskelet Disord. 2014;15(1):450.CrossRefGoogle Scholar
  9. 9.
    Lunn M, Hughes R, Wiffen P. P68 Duloxetine for treating painful neuropathy or chronic pain; a Cochrane systematic review. Neuromuscul Disord. 2010;20:S23.CrossRefGoogle Scholar
  10. 10.
    O’Connor A, Dworkin R. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. 2009;122(10A):S22–32.CrossRefGoogle Scholar
  11. 11.
    Tanenberg R, Clemow D, Giaconia J, Risser R. Duloxetine compared with pregabalin for diabetic peripheral neuropathic pain management in patients with suboptimal pain response to gabapentin and treated with or without antidepressants: a post hoc analysis. Pain Pract. 2013;14(7):640–8.CrossRefGoogle Scholar
  12. 12.
    Waldfogel J, Nesbit S, Dy S, Sharma R, Zhang A, Wilson L, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. Neurology. 2017;88(20):1958–67.CrossRefGoogle Scholar
  13. 13.
    Zilliox L. Neuropathic pain. Continuum. 2017;23:512–32.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kris Ferguson
    • 1
  • Nicole Wolfgram
    • 1
  1. 1.Aspirus HospitalWausauUSA

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