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.

Original languageEnglish
Title of host publicationClinical Pain Management
Subtitle of host publicationA Practical Guide, Second Edition
Number of pages8
ISBN (Electronic)9781119701170
ISBN (Print)9781119701156
StatePublished - Jan 1 2022


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