Mianserin and chronic pain: a double‐blind placebo‐controlled process and outcome study

Abstract

There is evidence that antidepressants may have an analgesic effect in chronic pain. To replicate this effect and to throw light on the processes involved, a 12-week cross-over double-blind trial of mianserin versus placebo was carried out in 4 diagnostic groups: A) depressive patients without pain complaints (n = 8), B) depressive patients with chronic organic pain (n = 8), C) patients with somatoform pain disorder and vital signs of depression (n = 11) and D) patients with chronic organic pain without depression (n = 8). Although a mianserin-induced antidepressant effect in group A was evident, no significant pain reduction was accomplished in any group. The reasons for this failure to replicate the antidepressant-induced analgesic effect are discussed.

Efficacy and Safety of Duloxetine 60 mg Once Daily in the Treatment of Pain in Patients With Major Depressive Disorder and At Least Moderate Pain of Unknown Etiology

“…1,2,37 The current study is one of the few placebo-controlled studies with the primary focus on pain in patients with depression and associated pain. 22,38,39 The current study has used 3 methodological approaches to investigate pain symptoms associated with depression in the absence of accepted diagnostic criteria or a definition: (1) excluding patients with a diagnosed organic pain syndrome, but requiring at least moderate pain severity at baseline, (2) selecting patients with at least 1 previous episode of depression, and (3) a confirmed diagnosis of major depressive episode using a structured diagnostic interview.…”

Somatization and chronic pain

“…In a study of 34 patients with somatoform pain disorder treated with amitriptyline with and without flupentixol in a crossover design, only 12 of the patients obtained a significant pain reduction (26). In a controlled, double‐blind crossover trial of miaserin versus placebo including 11 patients with somatoform pain disorder, no significant pain reduction was accomplished (27). Engel et al (28) treated 23 patients with sertraline for chronic benign pelvic pain and found no significant difference in outcome between the active drug and placebo.…”

Psychotropic Drugs for the Management of Chronic Pain and Itch

“…We suppose that this could be explained by sex difference; our trial demonstrated high efficacy of mianserin in men and a low effect in women. The other studies did not distinguish the effect of mianserin in males and females, but there were more women than men in the studied groups in all of them [193,194,195,196]. With regard to side effects, there were withdrawals and dropouts due to the following side effects: lack of appetite, dryness of mouth, thirst, drowsiness, and dullness [194,195,196].…”

“…In 1993, in a double-blind placebo-controlled study, the authors of [195] tested the analgesic effect of mianserin in the following groups: (1) patients with depression without pain, (2) patients with depression with chronic (organic) pain, (3) patients with psychosomatic disorders and signs of depression, (4) patients with chronic pain without depression. After a 12-week experiment, the scientists had not confirmed the analgesic effect of mianserin.…”