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Current Pain and Headache Reports
Erschienen in: Current Pain and Headache Reports 9/2019

01.09.2019 | Other Pain (A Kaye and N Vadivelu, Section Editors)

Off-label Antidepressant Use for Treatment and Management of Chronic Pain: Evolving Understanding and Comprehensive Review

verfasst von: Ivan Urits, Jacquelin Peck, Mariam Salisu Orhurhu, John Wolf, Riki Patel, Vwaire Orhurhu, Alan D. Kaye, Omar Viswanath

Erschienen in: Current Pain and Headache Reports | Ausgabe 9/2019

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Abstract

Purpose of Review

While clinicians have been using antidepressants for off-label indications in the treatment of chronic pain in recent years, newer studies have proven effectiveness and provided additional mechanistic understanding and defined potential adverse effects. As depression and chronic pain are frequently comorbid conditions, the use of antidepressants has allowed for treatment of both conditions concomitantly in the same patient population.

Recent Findings

The most commonly used antidepressants for chronic pain are tricyclic antidepressants (TCAs), though selective serotonin or noradrenaline reuptake inhibitors and other atypical antidepressants have been shown to be effective at treating chronic pain. In addition to neuropathic pain, bupropion has also demonstrated effectiveness in treating chronic pain caused by inflammatory bowel disease. Selective norepinephrine receptor inhibitors (SNRIs), including duloxetine, serve to suppress neuropathic pain by altering recovery of the noradrenergic descending inhibitory system in the spinal cord. While the direct mechanism of action is largely unknown, TCAs may suppress the noradrenergic descending inhibitory system to produce an antihyperalgesic effect.

Summary

The use of antidepressants offers alternative and adjunctive therapy options for patients suffering from chronic pain from various modalities. TCAs, mono-amine oxidase inhibitors, selective serotonin receptor inhibitors, SNRIs, and atypical antidepressants have been shown to have analgesic and sometimes antiinflammatory capabilities that are independent of their mood-stabilizing effects. Further studies are warranted to establish better safety profiles and efficacy of antidepressant use in chronic pain.
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Metadaten
Titel
Off-label Antidepressant Use for Treatment and Management of Chronic Pain: Evolving Understanding and Comprehensive Review
verfasst von
Ivan Urits
Jacquelin Peck
Mariam Salisu Orhurhu
John Wolf
Riki Patel
Vwaire Orhurhu
Alan D. Kaye
Omar Viswanath
Publikationsdatum
01.09.2019
Verlag
Springer US
Erschienen in
Current Pain and Headache Reports / Ausgabe 9/2019
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-019-0803-z

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