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

Windsor, R. Blake; Sierra, Michael; Zappitelli, Megan; McDaniel, Maria

doi:10.3390/children7120268

Cited by 7 publications

(3 citation statements)

References 150 publications

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“…If antipsychotics do little, if nothing, to alleviate pain, the same is not true for antidepressants. Tricyclics (amitriptyline and others, to mention a few) seem to be useful in chronic pain and their efficacy, although debatable, has warranted their long-term use, even among non-adults[ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric disorders and pain: The recurrence of a comorbidity

Vyshka¹

2022

WJCC

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Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance. Although pain is a common complaint among psychiatric patients, clinicians generally separate its presence from the background mental disorder and downplay its importance, trying primarily to control the psychiatric symptomatology. As a sensory modality, the presence of pain and its importance account for an impressive body of scholarly research. Cartesian methodology considered sensations of all modalities in a mechanistic form, which actually sounds obsolete. However, authors have continuously been faced with the same dilemmas plaguing scholars for centuries. We assume that a large portion of the sensory inputs might be generators of distorted perceptions, which subsequently lead to psychopathology. Auditory and visual hallucinations are incontestable examples. Somaesthetic hallucinations also exist, but pain hardly deserves such a denomination. Nevertheless, chronic pain and psychiatric comorbidity is a reality that needs explanation. Painkillers are not effective in treating psychiatric disorders, and antipsychotics do very little, perhaps nothing, to relieve pain. The pharmacological approach opens one door on the horizon and closes many others, while clinicians continue to face a high prevalence of comorbid pain and mental health issues. However, attempts to correlate altered body schemata (as distorted as it may be, for example, in phantom limb pain) with somatic delusions can simplify all these dilemmas, and the basket of psychophysiology, in fact, might be bigger than presumed.

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Section: Discussionmentioning

confidence: 99%

Psychiatric disorders and pain: The recurrence of a comorbidity

Vyshka¹

2022

WJCC

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“…Amitriptyline (AM) is a classical antidepressant tricyclic drug that has been also considered the treatment of choice for different types of chronic pain, including migraine and chronic myofascial pain. [19][20][21][22][23][24] Beyond its actions on the nervous system, AM has been shown to reduce the presence of inflammatory markers in a number of pathological conditions in human and in experimental animal models, including in our spongeinduced chronic inflammation. [25][26][27][28] Furthermore, modulatory activities of AM on angiogenesis and fibrogenesis have been reported.…”

Section: Introductionmentioning

confidence: 99%

Amitriptyline efficacy in decreasing implant‐induced foreign body reaction

et al. 2023

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Beyond its actions on the nervous system, amitriptyline (AM) has been shown to lower inflammatory, angiogenic, and fibrogenic markers in a few pathological conditions in human and in experimental animal models. However, its effects on foreign body reaction (FBR), a complex adverse healing process, after biomedical material implantation are not known. We have evaluated the effects of AM on the angiogenic and fibrogenic components on a model of implant‐induced FBR. Sponge disks were implanted subcutaneously in C57BL/6 mice, that were treated daily with oral administration of AM (5 mg/kg) for seven consecutive days in two protocols: treatment was started on the day of surgery and the implants were removed on the seventh day after implantation and treatment started 7 days after implantation and the implants removed 14 after implantation. None of the angiogenic (vessels, Vascular endothelial growth factor (VEGF), and interleukin‐1β (IL‐1β) or fibrogenic parameters (collagen, TGF‐β, and fibrous capsule) and giant cell numbers analyzed were attenuated by AM in 7‐day‐old implants. However, AM was able to downregulate angiogenesis and FBR in 14‐day‐old implants. The effects of AM described here expands its range of actions as a potential agent capable of attenuating fibroproliferative processes that may impair functionality of implantable devices.

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“…The reviews and studies on chronic pain cover a broad range of topics. The feature article by Windsor et al, provides a much-needed narrative review of psychotropic medications for the treatment of complex pain and headache disorders in children and adolescents [ 3 ]. Other studies cover very practical aspects of treatment and testing, including a study of the clinical utility of somatosensory testing by Kersch et al [ 4 ], and a review on the importance of pain education, by Koechlin et al [ 5 ].…”

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confidence: 99%