Historically, chronic pain has been treated with a variety of painkillers, psychotherapy, and lifestyle adjustments. But what if there was another option for pain management? New research suggests that antidepressants for chronic pain could offer promising results.
This, of course, raises many questions, both about what pain is and how to help people live with it. Understandably, some people feel skeptical about replacing pain medications with antidepressants. But let’s look at the science behind this idea and see how it has already helped people living with chronic pain.
The Subjectivity of Pain
Despite common pain ranking tools like the one to 10 pain scale, everybody feels and handles pain differently. Something that is a minor pain for you could be a major problem for somebody else, and this disparity has a lot to do with how our brains process and perceive pain.
In one study, researchers conducted functional magnetic resonance imaging (FMRI) sessions to see how different patients’ brains respond to pain. For their observations, they broke down pain into two categories: stimulus-related pain (pain caused by physical stimuli like injuries) and percept-related pain (pain that is subjective, like peripheral neuropathy).
Note that this distinction does not equate to “real pain” and “imagined pain.” In both of these categories, individuals are genuinely in pain and need pain management to live their lives. Percept-related pain does not mean pain that is made up or imagined, but pain that does not have a 100% physical basis.
Upon conducting the FMRIs, the researchers found patterns of how people experienced subjective pain alongside which parts of the brain were activated in the pain response. In general, people with percept-related pain showed more extensive activation in the parts of the brain that signal pain.
What does that mean? First, that pain without a physical cause can still activate parts of the brain that control pain, which tells us that this subjective pain is very real. Secondly, by identifying the parts of the brain that are activated in the pain response, pain specialists realized that these same parts of the brain can be activated by mental illnesses like depression. And if they activate the same parts of the brain, then similar medications could be helpful in pain management.
There is another reasoning in this approach as well; it has long been understood that mental well-being and physical pain are deeply connected. This is why, even in cases of injury-related pain, chronic pain sufferers are often encouraged to undergo mental health counseling. This not only gives individuals the ability to cope with pain, but it can also reduce the pain felt by addressing underlying mental health issues that would otherwise worsen existing pain.
Now that we’ve covered the motivation behind using antidepressants for chronic pain, let’s discuss the practical applications of this new treatment method.
Do Antidepressants for Chronic Pain Work?
In theory, it seems like there’s reason to believe that antidepressants could reduce chronic pain. But what about in real-world applications? Where is the evidence that antidepressants could replace painkillers?
Interestingly, there is some debate as to how exactly antidepressants help with chronic pain. The popular theory is that some part of how the antidepressant improves mood also impacts the parts of the brain that process pain and makes them less likely to send as many pain signals.
But even though the current research isn’t sure of the exact mechanism, there is no doubt that antidepressants work to lessen chronic pain. Across multiple studies, researchers have consistently seen lower pain levels in patients taking antidepressants. However, the results are dependent on two important factors.
Different Types of Pain React Differently to Antidepressants
When pain is caused by a physical injury or wound, antidepressants generally offer little benefit to the individual when compared to traditional painkillers. This is because the cause of the pain has more to do with a physical issue than with the way the brain perceives pain. There are exceptions, though, for chronic conditions that have a physical cause but cannot heal like a physical wound.
For example, antidepressants routinely treat chronic pain issues like:
Of course, some of these issues have physical causes, like arthritis and fibromyalgia. But unlike a wound, which can heal and stop causing pain, there is often no cure for issues like this. That’s why antidepressants can help; because the pain felt cannot be eliminated physically but can be lessened in the brain.
Of course, there is one other important factor in antidepressants for chronic pain: the type of antidepressant used. Because many different antidepressants work in a variety of ways, some are more effective than others when it comes to treating chronic pain.
Best Antidepressants for Chronic Pain
Generally, there are three different types of antidepressants you may be prescribed for chronic pain. Each one has demonstrated different efficacy with different conditions, so speak with your health care provider about which option could be best for you.
Tricylic Antidepressants (TCAs)
TCAs have been commonly prescribed since the 1950s. And while they have fallen out of favor as the go-to mental health treatment, they are the most common antidepressant to be prescribed for pain.
TCAs affect two important mood chemicals: serotonin and norepinephrine. Because norepinephrine plays a key role in neuropathic pain, TCAs are the most likely course of treatment for people living with neuropathies.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
If you have been diagnosed with depression, you may have been prescribed an SNRI. This is because they help balance out serotonin and norepinephrine in the brain, which can stabilize moods and prevent the emotional crashes of depression.
For chronic pain, only one SNRI has been FDA approved as a viable treatment. Duloxetine, commercially known as Cymbalta, may be prescribed to treat neuropathic pain due to its ability to increase available norepinephrine in the brain.
Selective Serotonin Reuptake Inhibitors (SSRIs)
The other common depression treatment, SSRIs can improve mood, but only affect serotonin, not norepinephrine. For this reason, they have shown less efficacy in helping with chronic pain management.
However, if TCAs and SNRIs prove unhelpful or have unpleasant side effects, SSRIs may still work to treat chronic pain. While it is less likely, it’s important to remember that because pain is subjective, even treatments that are generally less effective can still provide significant pain relief in the right individual.
Antidepressants Can Improve Pain Management
While painkillers can offer some pain relief, there is no doubt that antidepressants have distinct advantages. Perhaps the most obvious is that antidepressants are far less addictive than opioid painkillers, and it is much easier and safer to wean someone off of an antidepressant than an opioid.
Moreover, antidepressants can be doubly effective by improving the mental health effects that come with chronic pain. Everybody has bad pain days, and it’s not uncommon for chronic pain to cause depression. By minimizing pain and improving mood, antidepressants can offer even more advantages than opioids without as many risks.
If you’re interested in trying antidepressants for chronic pain, speak with your health care provider to discuss your options. They will want to consider the nature of your chronic pain, the severity of your pain, and your mental history. But for many people with chronic pain, antidepressants can make a substantial difference in safe pain management.
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