Some of the more effective and widely used chronic pain medications are medications designed to treat other conditions. Although antidepressants are not specifically designed to treat chronic pain, they are a major pillar in the treatment of many chronic pain conditions, although depression is not recognized as a factor.
Pain Relieving Types
Antidepressants appear to work best in pain caused by:
- Nerve damage from diabetes (diabetic neuropathy)
- Nerve damage from shingles (postherpetic neuralgia)
- Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, radiculopathy)  Tension headache
- Facial pain
- Low back pain
- Pelvic pain
The analgesic mechanism of these drugs is not yet completely understood. Antidepressants can increase neurotransmitters in the spinal cord, thereby reducing the pain signals. They do not work immediately.
You may feel some relief from an antidepressant after about a week, but the maximum relief may take several weeks. In humans, moderate pain relief usually occurs through antidepressants.
In case of incomplete pain relief with antidepressants, drugs from other classes of drugs with different mechanisms of pain relief (eg anticonvulsants) can be used in combination with drugs of the antidepressant class.
classified according to their chemical structure and their mode of operation. One of the most effective groups of antidepressants for pain is the tricyclic.
Tricyclic antidepressants are the most common type of antidepressant medication for pain. These include:
- imipramine (Tofranil)
- clomipramine (anafranil)
- nortriptyline (pamelor)
- desipramine (norpramine)
Anticlantioxidants from tricom can cause side effects of tricyclic antidepressants
- Dry mouth
- Drowsiness when getting up due to a fall in blood pressure (orthostatic hypotension)
- Weight gain  Difficulty in clear thinking
- Difficulty urination
- Cardiac arrhythmia
To reduce or prevent side effects, your doctor may start with a low dose and increase the amount slowly. Most people are able to take tricyclic antidepressants, especially in low doses, with only minor side effects. The pain-killing doses are generally lower than those used for depression.
Other Antidepressants That Can Help
Other classes of antidepressants have become more popular because they have fewer side effects. These medications can also be used to relieve chronic pain:
serotonin and norepinephrine reuptake inhibitors (SNRIs). Some SNRIs, such as venlafaxine (Effexor XR), duloxetine (Cymbalta), and milnacipran (Savella), help relieve chronic pain. People with chronic pain often develop depression together with their chronic pain. Venlafaxine and duloxetine have the advantage of being effective in treating depression and anxiety with the same pain treatment.
Venlafaxine can cause drowsiness, insomnia or high blood pressure and make heart problems worse. Duloxetine may cause side effects such as drowsiness, insomnia, nausea, dry mouth, dizziness, constipation or excessive sweating.
Milnacipran is used to relieve fibromyalgia pain and may cause side effects such as nausea and somnolence. However, it has only proven to be limited in relieving other types of pain.
Selective serotonin reuptake inhibitors (SSRIs). SSRIs that include drugs such as paroxetine (Paxil) and fluoxetine (Sarafem, Prozac) may be helpful in relieving certain types of pain, but there is no evidence that they help relieve neuropathic pain. However, fluoxetine may increase the analgesic effects of some tricyclic antidepressants.
SSRIs generally do not work as well as tricyclic antidepressants for pain, but often cause fewer side effects. Fluoxetine may cause certain side effects like insomnia and dizziness.
It is important to note that antidepressants are associated with a slightly increased risk of suicidal thoughts or actions. Talk to a doctor or consultant immediately if you feel depressed or suicidal.
Release date: 2001-12-19