Physical Medicine and Rehabilitation Clinics of North America
Antidepressant and Anticonvulsant Medication for Chronic Pain
Section snippets
Reasons for using antidepressants
There are three basic reasons for considering antidepressant medications for patients with chronic pain. First, psychiatric disorders are common in patients with severe or disabling chronic pain. Second, sleep disturbance is common, even in patients who do not meet criteria for psychiatric disorders. Third, there is evidence that certain classes of antidepressants produce pain relief separate from relief of depression or other psychiatric disorders.
Anticonvulsants
Pain specialists typically discuss anticonvulsants primarily in relation to neuropathic pain, and the clearest evidence for their efficacy comes from studies of patients with this type of pain. As a first approximation, one could say that anticonvulsants should be used with enthusiasm in patients with neuropathic pain and with caution in patients with other types of pain; unfortunately, this simple rule is beguiling because the boundaries around neuropathic pain are far from clear.
Case 1
The clinical information available on the patient in Case 1 in the introductory article suggests that his right lower extremity pain reflects a central pain syndrome. Although central pain syndromes represent a heterogeneous group of disorders with respect to the underlying CNS dysfunction, there is evidence that at least some of them respond to tricyclic antidepressants [80], [81], lamotrigine [82], and possibly gabapentin [83]. It should be assumed that a patient with a history of prolonged
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