Antidepressants, antipsychotics show potential for pain management, study finds

A range of medications commonly used to treat depression, anxiety, sleep disorders and other psychiatric conditions could help relieve pain and reduce reliance on opioid drugs, according to a new study by researchers at the University of California, San Francisco (UCSF).

The review examined existing medical literature on non-opioid medications available in emergency departments and identified several drugs that may be effective for treating common pain conditions, including abdominal pain, back pain, chest pain, fractures and headaches.

According to The Guardian, the findings come as healthcare providers continue to seek alternatives to opioids, which remain highly effective for pain management but have been linked to addiction and overdose risks that fueled the U.S. opioid crisis beginning in the 1990s.

Akash Shanmugam, a UCSF medical student and the study's lead author, said the goal was to "create a very targeted list for specific pain conditions", helping expand the "toolboxes" physicians use to treat patients.

Researchers found that widely used pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen showed potential benefits across all pain categories studied.

Other medications appeared more effective for specific conditions. Ketamine, commonly used as an anesthetic, showed promise for chest pain, while a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant may help treat back pain. Several antipsychotic drugs also demonstrated potential benefits for headaches and abdominal pain.

Both Shanmugam and Dr. Kathy LeSaint, an associate professor of emergency medicine at UCSF and co-author of the study, stressed that opioids continue to play an important role in pain treatment.

"The desire to reduce opioids shouldn't come at the expense of under-treating pain," Shanmugam said.

LeSaint said alternatives are important because patients can respond differently to opioid medications due to genetic factors affecting how their bodies metabolize the drugs.

"The enzymes that are responsible for metabolizing opioids can have different strengths in people," LeSaint explained.

Psychiatric medications have long been used in some pain treatments, particularly for nerve-related pain. Shanmugam noted that gabapentin, initially developed for epilepsy, is now widely used to manage neuropathic pain.

Researchers said the overlap between the brain circuits involved in pain perception and emotional processing may help explain why certain psychiatric medications can alleviate pain. Neurotransmitters such as dopamine, serotonin, norepinephrine and glutamate play roles in both mood regulation and pain signaling.

"Neural circuits that create the sensation of pain are also are involved in the emotional experience of pain, and the distress that pain produces for human beings," Shanmugam said.

According to LeSaint, antidepressants and antipsychotics may help reduce heightened nervous system sensitivity associated with chronic pain.

"In chronic pain conditions, the nervous system can become highly sensitive, and it's thought that antidepressants and antipsychotics can maybe reduce this heightened sensitivity in the brain," LeSaint said.

She added that medications that improve sleep and reduce anxiety may also help patients better cope with chronic pain, which is frequently associated with fatigue, depression and poor sleep.

"Chronic pain is often linked to things like poor sleep, depression, anxiety, fatigue," LeSaint said.

The researchers emphasized that treatment decisions should be tailored to individual patients and their medical histories.

"Talking to them and asking about their prior experience with opioids prior to giving opioids can be really helpful in tailoring the pain regimen for that particular patient, for that particular pain syndrome," LeSaint said.

Shanmugam said physicians should also explain why psychiatric medications may be prescribed for pain to avoid the perception that symptoms are being dismissed.

"I've seen a lot of clinicians use the basic science approach of explaining that there's a lot of overlap between the pain mechanisms and also the emotional understanding of pain," Shanmugam said, "that really helps reassure patients."

By Aghakazim Guliyev