Common biochemical factors between pain and depression suggests that
compounds inhibiting the reuptake of serotonin and/or noradrenaline
are likely to produce relief from chronic pain. Tricyclic antidepressants
have been a standard treatment of chronic pain for many years. In spite
of their improved tolerance, selective serotonin reuptake inhibitors
do not appear to be particularly effective in the treatment of pain.
Recently, a number of trials with the new selective serotonin and noradrenaline
reuptake inhibitor class of antidepressants, such as venlafaxine, milnacipran
and duloxetine, suggest that these compounds may be more effective in
relieving pain than selective inhibitors of serotonin reuptake. Wherever
valid comparisons have been made, the newer dual action drugs appear
to be as effective as the tricyclics and considerably better tolerated.
Dual action antidepressants are thus likely to become a widely used
treatment of chronic pain both associated with and independent of depression.
Briley M. “Clinical experience with dual action antidepressants
in different chronic pain syndromes.” Human Psychopharmacology.
19 Suppl 1:S21-5, 2004 Oct.