This article is one in a series on Medications for Pain…  What are your choices?  How do various medications work?  What are the pros and cons?  How about side effects?

Today we’ll look at the medication category of Antipsychotics.  The original use of antipsychotics is for psychiatric disorders like Schizophrenia or Bipolar Disorder, where a person’s thinking becomes disorganized.

Like many medication classes, antipsychotics aren’t FDA-approved for any pain disorders.  As well, instead of even a few good studies supporting their use, there are only a handful of “case reports,” each with only 1 patient in it.  So not only are antipsychotics not primary medications for pain, they are only rarely tried, to be used when other medications aren’t effective.

Effect of Antipsychotics:

The only antipsychotic for which I could find any report of its use in pain is Zyprexa.  Antipsychotics such as Zyprexa have an effect on many neurotransmitter systems, including dopamine and serotonin, so it’s not clear where its pain-relieving effect comes from.  As well, antipsychotics typically cause sedation, so some wonder if they help mainly through improving a patient’s sleep.

Side Effects:

• sedation (which can be helpful at night)
• dry mouth
• dizziness
• weight gain
• “metabolic syndrome” in some patients, which includes weight gain around the abdomen, increased blood pressure, and elevated lipids such as cholesterol and triglycerides

Specific Pain Disorders
In these case studies, Zyprexa had a positive effect when used for both neuropathic pain disorders and Rheumatoid Arthritis (RA), an inflammatory pain disorder.  This is quite interesting, as these are 2 different types of pain disorders.  Medication more commonly works in 1 type of pain, but not both.  For example, anti-inflammatory medication works in RA, but not neuropathic pain disorders, such as the pain which occurs in diabetes.

While these medications may be worthwhile to study for their effect on pain, currently they should only be used when other more traditional medication has not worked.

In this series:

1. Medication for Pain Series 2009
2. Aspirin, Motrin and NSAIDS
3. Anticonvulsants
4. Antidepressants
5. Anesthetics
6. NMDA receptor antagonists (e.g. Ketamine)
7. Muscle relaxants
8. Blood Pressure Medication
9. Narcotics (Opiates)
10. Anti-Psychotics
11. Medication Advances Coming Soon
12. Research Advances