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Antipsychotics for patients with pain.

Sang Wook Shin1, Jin Seong Lee2, Salahadin Abdi3

  • 1Department of Anesthesia and Pain Medicine, Pusan National University, Busan, Korea.

The Korean Journal of Pain
|January 24, 2019
PubMed
Summary

Antipsychotics, less common than antidepressants for pain, may treat pain as adjuvant analgesics. Newer atypical antipsychotics offer fewer extrapyramidal symptoms but carry metabolic risks.

Keywords:
AntipsychoticsD2 receptor antagonistsDopamineDrug related side effects and adverse reactionsExtrapyramidal symptomHistaminePainProlactinPsychosisSerotoninWeight gain

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Area of Science:

  • Neuroscience
  • Pharmacology
  • Pain Management

Background:

  • Pain is an unpleasant sensory and emotional experience.
  • Antipsychotics are being explored as adjuvant analgesics for pain management.
  • Atypical antipsychotics have a different receptor binding profile than typical antipsychotics, potentially reducing side effects.

Purpose of the Study:

  • To review the use of antipsychotics in pain management.
  • To compare the receptor binding profiles of typical and atypical antipsychotics.
  • To discuss the potential benefits and risks of using antipsychotics for pain.

Main Methods:

  • Literature review of antipsychotic use in pain management.
  • Comparison of receptor affinities (dopamine, serotonin, adrenergic, histamine, muscarinic) of various antipsychotics.
  • Analysis of side effect profiles, including extrapyramidal symptoms and metabolic syndromes.

Main Results:

  • Atypical antipsychotics have weaker D2 receptor binding and stronger 5-HT2A receptor binding compared to typical antipsychotics.
  • Antidepressants primarily block serotonin and norepinephrine reuptake, with less effect on dopamine receptors.
  • Antipsychotics are primarily indicated for positive symptoms of psychosis, not negative or cognitive symptoms.

Conclusions:

  • Atypical antipsychotics may offer a safer alternative to typical antipsychotics for pain management due to reduced extrapyramidal symptoms.
  • Metabolic syndromes are a significant risk associated with atypical antipsychotics.
  • Antipsychotics may be considered for pain patients with co-occurring positive psychotic symptoms.