Antidepressants are important analgesic adjuncts in the treatment of chronic non-cancer pain. This chapter is based on systematic reviews of high-quality randomized clinical trials of antidepressant agents in multiple chronic non-cancer pain conditions. Three classes of antidepressant agents have been widely tested for efficacy in chronic pain: Tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors (SSRIs). Serotonin-norepinephrine reuptake inhibitors, developed shortly after SSRIs, proved more efficacious in treatment of chronic pain. This pharmacologic class includes the medications duloxetine, venlafaxine, desvenlafaxine and milnacipran. Systematic reviews and meta-analyses support the use of TCAs for headache disorders and various neuropathic pain conditions, but not for chronic low back pain. Evidence is equivocal for TCA use in fibromyalgia.
|Title of host publication||Clinical Pain Management|
|Subtitle of host publication||A Practical Guide, Second Edition|
|Number of pages||8|
|State||Published - Jan 1 2022|