[Why using antidepressants in chronic pain ? Practical prescription recommendations]

Area of Science:

• Pharmacology
• Neurology
• Pain Management

Background:

• Antidepressants with serotonergic and noradrenergic properties have been used for 50 years for neuropathic and chronic pain.
• Their use is based on a plausible analgesic mechanism and demonstrated efficacy in humans and animals.
• These medications should be integrated into a multimodal pain management strategy.

Purpose of the Study:

• To review the rationale and application of dual-action antidepressants in pain management.
• To highlight the potential for analgesic effects independent of mood alteration.
• To discuss dosing considerations and factors influencing antidepressant selection for pain.

Main Methods:

• Review of existing literature on the use of dual-action antidepressants for pain.
• Analysis of proposed mechanisms of action for pain relief.
• Examination of clinical data regarding efficacy and dosing.

Main Results:

• Antidepressants with both serotonergic and noradrenergic effects show efficacy in managing neuropathic and chronic pain.
• Analgesic effects can occur at doses lower than those required for antidepressant effects.
• Pain relief is typically observed within an average of four weeks of treatment initiation.

Conclusions:

• Dual-action antidepressants are a valuable component of multimodal pain therapy.
• Dosing should be tailored to achieve analgesic effects, which may differ from antidepressant dosing.
• Patient-specific factors, including side effect profiles and comorbidities, should guide the choice of antidepressant.