A Systematic Review of Atypical Antipsychotics in Chronic Pain Management

Abstract

Few studies have been conducted to evaluate the analgesic effects of AAs. The collective findings of multiple studies evaluating olanzapine in pain syndromes suggest a high, yet preliminary level of evidence of efficacy, warranting prospective studies in various pain syndrome contexts. Pharmacological mechanisms of AA action are elaborated, and the findings of this review are discussed. Risk and benefits of using AAs in chronic pain are described, and investigational implications and future directions are explored.

Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review

“…To cover these limitations, dopaminergic medications might be helpful in some cases [63, 64]. Nevertheless, they should not be prescribed easily [65].…”

Loxapine for Treatment of Patients With Refractory, Chemotherapy-Induced Neuropathic Pain: A Prematurely Terminated Pilot Study Showing Efficacy But Limited Tolerability

“…In fact, the atypical antipsychotic drug quetiapine differs from other atypical and typical antipsychotic drugs by its antidepressant activity, which seems to be mediated by its metabolite N -desalkylquetiapine through partial 5-HT 1A agonism and inhibition of the norepinephrine reuptake transporter (Jensen et al, 2008). The latter mechanism might also mediate analgesic effects that have been reported in clinical trials (Jimenez et al, 2018).…”

“…In subject #4, analgesic treatment at the screening visit included ibuprofen, morphine, pregabalin, and quetiapine, an atypical antipsychotic drug with potentially analgesic properties (Jensen et al, 2008; Jimenez et al, 2018). Quetiapine was discontinued the day before the first intake of loxapine; all other drugs were pursued during the study.…”

Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders

“…Now that second generation (atypical) antipsychotics, are more widely used and available, the use of antipsychotics in the treatment of patients with pain symptoms is being revisited for treatment of pain and headache in adults. This is because of their multiple mechanisms of action and evidence of efficacy for treating many co-morbidities associated with pain including insomnia, refractory depression, and anxiety [139][140][141][142]. Atypical anti-psychotics affect many receptors that may modulate pain including 5-HT receptor agonism and antihistaminic, anti-alpha adrenergic, and anticholinergic activity.…”