Psychotropic medications for chronic pain

Psychotropic medications for chronic pain medstat_tb_rest Tue, 11/01/2022 - 01:00

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Psychotropic medications for chronic pain

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Abyaz Asmar, MBBS

Noor-Us-Sabah Ahmad, MBBS

Muhammad Hassan Majeed, MD

The opioid crisis presents a need to consider alternative options for treating chronic pain. There is significant overlap in neuroanatomical circuits that process pain, emotions, and motivation. Neurotransmitters modulated by psychotropic medications are also involved in regulating the pain pathways.1,2 In light of this, psychotropics can be considered for treating chronic pain in certain patients. The Table1-3 outlines various uses and adverse effects of select psychotropic medications used to treat pain, as well as their psychiatric uses.

In addition to its psychiatric indications, the serotonin-norepinephrine reuptake inhibitor duloxetine is FDA-approved for treating fibromyalgia and diabetic neuropathic pain. It is often prescribed in the treatment of multiple pain disorders. Tricyclic antidepressants (TCAs) have the largest effect size in the treatment of neuropathic pain.2 Cyclobenzaprine is a TCA used to treat muscle spasms. Gabapentinoids (alpha-2 delta-1 calcium channel inhibition) are FDA-approved for treating postherpetic neuralgia, fibromyalgia, and diabetic neuropathy.1,2

Ketamine is an anesthetic with analgesic and antidepressant properties used as an IV infusion to manage several pain disorders.2 The alpha-2 adrenergic agonists tizanidine and clonidine are muscle relaxants2; the latter is used to treat attention-deficit/hyperactivity disorder and Tourette syndrome. Benzodiazepines (GABA-A agonists) are used for short-term treatment of anxiety disorders, insomnia, and muscle spasms.1,2 Baclofen (GABA-B receptor agonist) is used to treat spasticity.2 Medical cannabis (tetrahydrocannabinol/cannabidiol) is also gaining popularity for treating chronic pain and insomnia.1-3

References

1. Sutherland AM, Nicholls J, Bao J, et al. Overlaps in pharmacology for the treatment of chronic pain and mental health disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):290-297.

2. Bajwa ZH, Wootton RJ, Warfield CA. Principles and Practice of Pain Medicine. 3rd ed. McGraw Hill; 2016.

3. McDonagh MS, Selph SS, Buckley DI, et al. Nonopioid Pharmacologic Treatments for Chronic Pain. Comparative Effectiveness Review No. 228. Agency for Healthcare Research and Quality; 2020. doi:10.23970/AHRQEPCCER228

Article PDF

CP02111047.pdf

Author and Disclosure Information

Drs. Asmar and Ahmad are MBBS graduates of King Edward Medical University, Lahore, Pakistan. Dr. Majeed is a psychiatrist and interventional pain physician, Allentown, Pennsylvania.

Disclosures
The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.

Issue

Current Psychiatry - 21(11)

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MDedge Psychiatry

Current Psychiatry

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Pain

Page Number

47-48

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Pearls

Reviews

Author(s)

Abyaz Asmar, MBBS

Noor-Us-Sabah Ahmad, MBBS

Muhammad Hassan Majeed, MD

Author(s)

Abyaz Asmar, MBBS

Noor-Us-Sabah Ahmad, MBBS

Muhammad Hassan Majeed, MD

Author and Disclosure Information

Drs. Asmar and Ahmad are MBBS graduates of King Edward Medical University, Lahore, Pakistan. Dr. Majeed is a psychiatrist and interventional pain physician, Allentown, Pennsylvania.

Disclosures
The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.

Author and Disclosure Information

Drs. Asmar and Ahmad are MBBS graduates of King Edward Medical University, Lahore, Pakistan. Dr. Majeed is a psychiatrist and interventional pain physician, Allentown, Pennsylvania.

Disclosures
The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.

Article PDF

CP02111047.pdf

Article PDF

CP02111047.pdf

The opioid crisis presents a need to consider alternative options for treating chronic pain. There is significant overlap in neuroanatomical circuits that process pain, emotions, and motivation. Neurotransmitters modulated by psychotropic medications are also involved in regulating the pain pathways.1,2 In light of this, psychotropics can be considered for treating chronic pain in certain patients. The Table1-3 outlines various uses and adverse effects of select psychotropic medications used to treat pain, as well as their psychiatric uses.

In addition to its psychiatric indications, the serotonin-norepinephrine reuptake inhibitor duloxetine is FDA-approved for treating fibromyalgia and diabetic neuropathic pain. It is often prescribed in the treatment of multiple pain disorders. Tricyclic antidepressants (TCAs) have the largest effect size in the treatment of neuropathic pain.2 Cyclobenzaprine is a TCA used to treat muscle spasms. Gabapentinoids (alpha-2 delta-1 calcium channel inhibition) are FDA-approved for treating postherpetic neuralgia, fibromyalgia, and diabetic neuropathy.1,2

Ketamine is an anesthetic with analgesic and antidepressant properties used as an IV infusion to manage several pain disorders.2 The alpha-2 adrenergic agonists tizanidine and clonidine are muscle relaxants2; the latter is used to treat attention-deficit/hyperactivity disorder and Tourette syndrome. Benzodiazepines (GABA-A agonists) are used for short-term treatment of anxiety disorders, insomnia, and muscle spasms.1,2 Baclofen (GABA-B receptor agonist) is used to treat spasticity.2 Medical cannabis (tetrahydrocannabinol/cannabidiol) is also gaining popularity for treating chronic pain and insomnia.1-3

The opioid crisis presents a need to consider alternative options for treating chronic pain. There is significant overlap in neuroanatomical circuits that process pain, emotions, and motivation. Neurotransmitters modulated by psychotropic medications are also involved in regulating the pain pathways.1,2 In light of this, psychotropics can be considered for treating chronic pain in certain patients. The Table1-3 outlines various uses and adverse effects of select psychotropic medications used to treat pain, as well as their psychiatric uses.

In addition to its psychiatric indications, the serotonin-norepinephrine reuptake inhibitor duloxetine is FDA-approved for treating fibromyalgia and diabetic neuropathic pain. It is often prescribed in the treatment of multiple pain disorders. Tricyclic antidepressants (TCAs) have the largest effect size in the treatment of neuropathic pain.2 Cyclobenzaprine is a TCA used to treat muscle spasms. Gabapentinoids (alpha-2 delta-1 calcium channel inhibition) are FDA-approved for treating postherpetic neuralgia, fibromyalgia, and diabetic neuropathy.1,2

Ketamine is an anesthetic with analgesic and antidepressant properties used as an IV infusion to manage several pain disorders.2 The alpha-2 adrenergic agonists tizanidine and clonidine are muscle relaxants2; the latter is used to treat attention-deficit/hyperactivity disorder and Tourette syndrome. Benzodiazepines (GABA-A agonists) are used for short-term treatment of anxiety disorders, insomnia, and muscle spasms.1,2 Baclofen (GABA-B receptor agonist) is used to treat spasticity.2 Medical cannabis (tetrahydrocannabinol/cannabidiol) is also gaining popularity for treating chronic pain and insomnia.1-3

References

1. Sutherland AM, Nicholls J, Bao J, et al. Overlaps in pharmacology for the treatment of chronic pain and mental health disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):290-297.

2. Bajwa ZH, Wootton RJ, Warfield CA. Principles and Practice of Pain Medicine. 3rd ed. McGraw Hill; 2016.

3. McDonagh MS, Selph SS, Buckley DI, et al. Nonopioid Pharmacologic Treatments for Chronic Pain. Comparative Effectiveness Review No. 228. Agency for Healthcare Research and Quality; 2020. doi:10.23970/AHRQEPCCER228

References

1. Sutherland AM, Nicholls J, Bao J, et al. Overlaps in pharmacology for the treatment of chronic pain and mental health disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):290-297.

2. Bajwa ZH, Wootton RJ, Warfield CA. Principles and Practice of Pain Medicine. 3rd ed. McGraw Hill; 2016.

3. McDonagh MS, Selph SS, Buckley DI, et al. Nonopioid Pharmacologic Treatments for Chronic Pain. Comparative Effectiveness Review No. 228. Agency for Healthcare Research and Quality; 2020. doi:10.23970/AHRQEPCCER228

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Current Psychiatry - 21(11)

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Current Psychiatry - 21(11)

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47-48

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MDedge Psychiatry

Current Psychiatry

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Psychotropic medications for chronic pain

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