This antidepressant can help treat chronic pain

The most common chronic pain conditions observed by researchers were fibromyalgia, neuropathic pain, and musculoskeletal pain.

Of the 25 antidepressants studied, only duloxetine, a type of selective norepinephrine reuptake inhibitor (SNRI) was effective in reducing pain.

The researchers found that in a sample of 1,000 people, 435 people, or about 43%, would see their pain reduced by half. Comparatively, the researchers found that only 287 or 28.7 percent of people would see the same pain relief if they took a placebo.

The researchers describe the effect of duloxetine as “moderate” and also found that a higher dose than the standard 60 milligrams did not change the magnitude of the effect experienced by study participants.

The average length of the studies studied was about ten weeks, so the researchers were unable to determine whether duloxetine — or any other regularly prescribed antidepressant — could provide long-term pain relief.

Dr. Christine Gibson (MD) says the research has the potential to help, especially when it comes to managing people’s pain without using opioids.

Gibson said that many times chronic pain sufferers end up being prescribed off-label drugs, and many of those drugs can have side effects.

“I don’t find all of this tolerable for people,” Gibson said. “And whenever I can, I deprescribe, so it’s nice to know there was reasonable efficacy.”

Gibson also says that, in his experience, people often take many other medications before getting a prescription for duloxetine. Gibson said it’s important for doctors to think about the mental and financial impacts of prescribing so many drugs to people with chronic pain.

“By the time people get to duloxetine, for me, they’re usually taking about eight pills a day, or 30 pills a day. Like, it’s not a small pill burden,” Gibson said. “And I I’m just very curious about the experience of people who suffer, and they try everything…you’ll try NSAIDs, you’ll try Tylenol and then you’ll add duloxetine.

Dr. Mirela Loftus (MD, PhD) of Newport Healthcare says she would have liked to see how these drugs also impact chronic pain in people with anxiety and depression.

“I would like to see studies that don’t exclude patients with comorbid mental disorders, because that would mimic the kind of patients we see in the community, in real life,” Loftus said. “Inclusion of these patients may allow us to better understand whether depression and anxiety are improved along with pain when treated with antidepressants. It may also offer a window into the interconnection between pain and mental health, and how they influence each other.

Loftus, who has spent part of his career researching experimental treatments for depression, thinks research like this could lead practitioners away from SSRIs (selective serotonin reuptake inhibitors) in favor of SNRIs (serotonin reuptake inhibitors). reuptake of serotonin and norepinephrine), the class of drugs that duloxetine and milnacipran belong to, as first-line treatment. She says this type of research methodology makes sense when considering the connection between mind and body.

“There is no denying that our physical well-being, or lack thereof, will have a significant impact on our mental health. Therefore, the idea of ​​using antidepressants to treat either depression and anxiety secondary to chronic pain, or the pain itself, is now the standard of care,” Loftus said.