Antidepressants for Pain

It’s something I’ve heard a lot, I even said it myself, “Why did my rheumatologist give me an antidepressant? I am not depressed!” Then we begin to wonder, “Does he think I’m depressed? Wow, maybe I am depressed.” Next thing you know, you are depressed! Don’t fret; chances are it was prescribed for pain relief and to help you sleep, not as an antidepressant. 

How does it work on pain? Good question. Many authorities believe that the analgesic effects of antidepressants are due to their modulation of serotonin activity. Others say those of us with chronic pain are depressed to some degree whether we know it or not, the pain relief simply comes from an improved mental outlook. No one really knows for sure.

We may not know how it works, but it does seem to work. Over 40 double-blind, placebo-controlled, randomized trials have been performed to investigate the analgesic effects of antidepressants in many different chronic pain conditions. Patients with acute low back pain receiving 150 mg/d of amitriptyline experienced greater pain reduction than those taking 4000 mg/d of acetaminophen. Amitriptyline proved significantly better than placebo in decreasing measures of pain intensity in a study of 47 people with rheumatoid arthritis. 

According to some experts, fibromylagia is perhaps the type of arthritis most likely to respond to antidepressants. Two well-designed, randomized, controlled trials involving patients with fibromylagia showed that amitriptyline and fluoxetine improve pain- and sleep-related difficulties significantly better than placebo. Other clinical trials show that both amitriptyline and cyclobenzaprine are effective in fibromyalgia. The recommended dose of these drugs (10 to 50 mg of amitriptyline and 10 to 30 mg of cyclobenzaprine) is much smaller than the dose used in the treatment of depression.

So when your doctor says, “Take this every night and you’ll feel better in a couple of weeks.” He is not talking about your mind; he is talking about your pain. Give it a chance…it just might work.

The use of analgesics in the management of pain in rheumatic diseases. 
Rheumatic Diseases Clinics of North America
Volume 25 o Number 1 o February 1999
Copyright ? 1999 W. B. Saunders Company
Glenn A. McCain MD, FACP 
Rheumatic Diseases Clinics of North America
Volume 22 o Number 2 o May 1996
Copyright ? 1996 W. B. Saunders Company