Welcome to the continuing series Why You Should See a Pain Management Psychiatrist. This week we’ll look at using psychiatric medication for pain.
Antidepressants can be used for chronic pain itself, separately from treating depression. This means they are sometimes prescribed even if someone has no depression – just to treat pain itself. Let’s look at 3 different categories of antidepressants used to treat pain.
1. SNRI (Serotonin-norepinephrine reuptake inhibitors)
It seems that “dual-action” antidepressants, those that work on both the serotonin and the norepinephrine systems, also help with pain. An example is Cymbalta, which has been shown to be helpful in both Diabetic Peripheral Neuropathy and Fibromyalgia.
2. Tricyclics (TCA)
These are older antidepressants and have been shown to help in many different pain disorders. In fact, they are the most-studied antidepressants for pain. However, even though they work, they are not FDA-approved to treat pain. Examples include Amitriptyline (Elavil) and Nortriptyline (Pamelor).
3. SSRI (Selective serotonin reuptake inhibitors)
There is some evidence, thought research has been mixed, that SSRI’s may help with headaches, both migraines and Chronic Daily Headache.
Overall, antidepressants are sometimes helpful in treating pain itself. As we know, pain often exists along with depression and anxiety, so these medications might be a good choice when psychiatric symptoms are present along with pain. Using 1 medication for multiple symptoms is a good idea.
An important point to remember is that if your doctor recommends an antidepressant, it doesn’t mean the pain is “in your head” or that you’re simply imagining your pain.
Other articles in the series:
- Why comprehensive treatment works better
- Benefits of a psychiatric evaluation
- Treatment of psychiatric symptoms
- Using psychiatric medications for pain
- Learning psychological skills
- Making positive behavioral changes
- Making positive psychological changes
- Benefits of supportive therapy
- Benefits of a pain support group
- New brain-based treatments
5 responses so far ↓
len // Jun 22, 2009 at 8:48 am
i would like to hear from people who have had some degree of pain relief from antidepressants. and which medications gave them relief.also any combinations of meds that have helped them. it would also be helpful to hear from people who suffer from failed back syndrome, and how they cope with this condition. it would also be helpful to get more information on spinal cord stimulators, morphine pumps from people who have had these proceedures
mo // Aug 13, 2009 at 12:32 pm
I tried Cymbalta but I started having very bad side effects including twitches and tremors so I am now trying Effexor. It does help with the burning sensations from sciatica but it isn’t enough on it’s own.
Gabapentin is a better choice for the burning, numbness, and tingling.
I have had one back surgery and will not be having any more as the research shows the more surgery you have on your back the worse the outcomes are. I tried decompression and discotomy and had great results for three years until I had a violent patient encounter and re-injured.
I cope by taking a ton of drugs and having goals. I am in the middle of a combined Bachelors/Masters advanced Nurse Practitioner program that will allow me to return to nursing in a different modified way.
I walk everyday, I start my day with a short yoga stretching routine so I can move. I try to fill my diet with a lot of fresh fruit so I planted a huge garden full of strawberries and raspberries that my family can barely keep up with. Vegetables are also important so my garden is full of beets, potatoes, peas etc…I grow a lot of root vegetables so in the winter I can still eat my own produce year round. It takes very little effort to create a good garden, you just need someone to turn the soil for you at the start of planting and to do the picking but don’t let the picker eat all your strawberries.
New research has shown that except for surgery there are no statistically significant interventions that provide any lasting relief. Epidural steroid injections may provide a week or two’s relief if you can tolerate them and spinal cord stimulation can be helpful except for most patients have repeated issues with the implant including infection that the risk isn’t worth the minimal help it provides. More importantly why would you get a morphine pump? Why not rely on a non narcotic? If you need pain relief morphine comes in a long acting pill. I found morphine to be over sedating and because I need my brain to function I use oxycontin in a minimal dose for pain.
I can honestly say that having constant pain and crappy doctors unwilling to take the time to truly investigate why is what leads to despair. It’s not the pain, it’s the lack of care once doctors reach for and slap that chronic pain label on you. Being labeled with chronic pain means no doctor needs to provide any care other than write your prescriptions.
How to Cope with Pain // Aug 13, 2009 at 7:03 pm
Mo, it’s good to hear you’ve found an assortment of things that do work for you. Put aside what doesn’t work, and focus on what does, right?
Jacqueline // Aug 27, 2009 at 3:44 am
Hello,
To the lady who mentioned getting slapped as a chronic pain sufferer; how do you get the doctors to give you the pain medication so easily? My sister suffers from sciatica from getting hit by a car, and having two fused vertabrae, just short of being crippled. She’s also overweight which adds to the chronic pain, she can’t get so much as codeine from the doctors, and she has to fight for that. She suffers extremely. She’s almost bedridden, so she can’t exercise much. A doctor use to give her oxycotin, but they stopped that particular clinic from ditributing that type of medication. Tell me , can you suggest what kind, or what doctor she can go see to help her with her pain? Thank you for listening, I look forward to hearing your opinion. My sister really needs help, her quality of life is not good at all; I’m quite concerned.
Sincerely,
Jacqueline
How to Cope with Pain // Aug 27, 2009 at 9:44 am
Jacqueline, sorry to hear your sister is having problems. It might be helpful to have a discussion with her pain doctor about overall management, rather than focusing on 1 medication. Given that she’s not doing well, ask what the plan is to increase quality of life.
Also, most of the time, a plans includes multiple medications as well as an array of pain management treatment. So ask what other types of medication might be helpful, as well as other treatments – PT? psychological pain management? injections? acupuncture?
Good luck! And thanks to you for being supportive of your sister.
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