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Efficacy and Safety of Antidepressants as Analgesics in Chronic Pain: A Review

Published online by Cambridge University Press:  23 March 2020

J. Fennema ,
S. Petrykiv ,
L. de Jonge  and
M. Arts
J. Fennema
Affiliation:
GGZ Friesland, Geriatric Psychiatry, Leeuwarden, The Netherlands
S. Petrykiv
Affiliation:
University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
L. de Jonge
Affiliation:
Leonardo Scientific Research Institute, Department of Geriatric Psychiatry, Groningen, The Netherlands
M. Arts
Affiliation:
University of Groningen, University Medical Center Groningen, Department of Old Age Psychiatry, Groningen, The Netherlands

Abstract

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Introduction

Due to the aging population worldwide, chronic pain is becoming an important public health concern. Chronic pain is bidirectional associated with psychiatric disorders including depression and anxiety. Antidepressants are widely used as adjuvant therapy for the treatment of chronic pain for many disorders.

Objectives and aims

To review available literature on the efficacy and safety of antidepressants for the treatment of chronic pain, including neuropathic pain, fibromyalgia, low back pain, and chronic headache or migraine.

Methods

We performed a detailed literature review through PubMed, EMBASE and Cochrane's Library to assess the efficacy and safety of antidepressants in chronic pain conditions.

Results

In neuropathic pain, fibromyalgia, low back pain, and chronic headaches/migraine, tricyclic antidepressants (TCAs) showed a significant analgesic effect. Selective serotonin reuptake inhibitors (SSRIs) are not effective for the treatment of low back pain and headaches or migraine. Venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI) showed significant improvement of fibromyalgia and neuropathic pain. Duloxetine (SNRI) also reduced the pain in fibromyalgia.

Conclusion

TCAs are the ‘gold standard’ antidepressant analgesics. However, an electrocardiogram and postural blood pressure should be implemented prior to TCA treatment and TCAs should be initiated at low dosages and subsequently increased to the maximum tolerated dose. One should pay attention to their cardiotoxic potential, especially in the older population. For the treatment of neuropathic pain, SNRIs are second-line agents. Although better tolerated, in most types of chronic pain conditions, the effectiveness of SSRIs is limited. To conclude: start low, go slow, and prescribe with caution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-poster walk: Consultation liaison psychiatry and psychosomatics–Part 1
Information
European Psychiatry , Volume 41 , Issue S1: Abstract of the 25th European Congress of Psychiatry , April 2017 , pp. S234
Copyright
Copyright © European Psychiatric Association 2017
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