Antidepressant Use in Chronic Pain Management

Abstract

BACKGROUND: Duloxetine is a novel antidepressant that is anticipated to be clinically available soon. It exerts simultaneous noradrenergic and serotonergic neurotransmitter effects. Because of these influences, it is postulated to have a role in management of pain. DATA SOURCES: An Index Medicus search from 1997 to 2003 was conducted using the search terms duloxetine, Cymbalta, and pain. DATA ANALYSIS: Preclinical animal studies suggest that duloxetine may have a direct analgesic role. Premarketing studies have emphasized its utility in alleviating somatic, specifically pain, complaints among patients with major depression. CONCLUSION: Although promising, these results cannot be generalized to patients with pain disorders; the reasons for this are discussed herein. While duloxetine may be useful among somatizing depressed patients and possibly chronic pain patients with comorbid depression, its analgesic role has yet to be elucidated in future research.

Antidepressants Effects on Pain in Parkinson Disease: A Systematic Review

“…42 In terms of efficacy in treating pain, mixed results have further been reported on SSRIs and other serotonergic antidepressants, including venlafaxine and duloxetine. 42 Duloxetine has been investigated to treat pain in PD, 37,43 with reports of central pain relief up to 65% of treated people. 43 However, in this study, depressed PwPD were excluded to avoid attributing the beneficial effect of duloxetine in PD pain to the antidepressant properties.…”

“…In the management of neuropathic pain, paroxetine and citalopram have been shown to demonstrate modest efficacy, whereas fluoxetine has not 41 . The bulk of the evidence has supported the use of TCAs for ameliorating pain; however, adverse effects related to the anticholinergic effects may be particularly disabling in PwPD 42 . In terms of efficacy in treating pain, mixed results have further been reported on SSRIs and other serotonergic antidepressants, including venlafaxine and duloxetine 42 .…”

“…41 The bulk of the evidence has supported the use of TCAs for ameliorating pain; however, adverse effects related to the anticholinergic effects may be particularly disabling in PwPD. 42 In terms of efficacy in treating pain, mixed results have further been reported on SSRIs and other serotonergic antidepressants, including venlafaxine and duloxetine. 42 Duloxetine has been investigated to treat pain in PD, 37,43 with reports of central pain relief up to 65% of treated people.…”