In honor of the American tradition of Thanksgiving, November’s Pain-Blog Carnival theme will be thankfulness.  (Preference will be given to articles on this theme, although others will be considered.)  The deadline for November’s carnival will be Monday, November 26, and the carnival will be Friday, November 30.  Please submit your article here.

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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?  (Discuss these ideas with your doctor.  Don’t make any changes to your treatment by yourself.)

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

Like many medication classes, anti-psychotics 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 anti-psychotics not primary medications for pain, they are only rarely tried, to be used when other medications aren’t effective.

Effect of Anti-Psychotics:

The only anti-psychotic for which I could find any report of its use in pain is Zyprexa.  As anti-psychotics such as Zyprexa have an effect on many neurotransmitter systems, including dopamine and serotonin, it’s not clear where its pain-relieving effect comes from.  As well, anti-psychotics 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
While not approved for any pain disorders, Zyprexa was reported in these case studies to have a positive effect when used for both neuropathic pain disorders as well as Rheumatoid Arthritis (RA), an inflammatory pain disorder.  This is quite interesting, as these are 2 different types of pain disorders.  Many medications work in 1 of the types 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 as a last resort.

Next Monday, we’ll look at Narcotic (Opiate) Medication for pain.  Other articles in this series:

• Medication 101:  What Are My Options For Pain Treatment
• NSAIDS:  Aspirin, Motrin, Celebrex
• Anticonvulsants
• Antidepressants
• Anesthetics
• Ketamine
• Muscle Relaxants
• Blood Pressure Medication
• Narcotics (Opiates)
• Medication Advances Coming Soon
• Research Advances