CHECK-UP:How prescribing antidepressants can sometimes help in pain relief
I’VE BEEN taking pain killers for a number of years for osteoarthritis. At this stage they do not seem to be making any difference to my pain levels, so my GP has suggested I start taking antidepressants. I’m not depressed, so why does he want to prescribe them?
Drugs that are not usually routinely prescribed for the treatment of pain but can be used to relieve it in certain circumstances are called adjuvant analgesics. These drugs include antidepressants, anticonvulsant medications and some anaesthetic drugs used orally or topically.
Antidepressants have the potential to relieve pain in people who are not suffering from depression. While older types such as tricyclic antidepressants have been shown to work best when it comes to pain control, newer types known as selective serotonin reuptake inhibitors (SSRIs) may also be used.
While one antidepressant may relieve pain in one person it may not work for another, so it is often a case of trial and error to find the best drug to control pain while causing the fewest side effects.
Apart from antidepressants, what are the other drugs that can help control pain?
The type of adjuvant analgesic used will depend very much on the type of pain experienced. Nerve pain can be relieved by anticonvulsant medications such as carbamazepine, phenytoin and gabapentin. Some anticonvulsants can even be used to prevent migraine headache.
Topical anaesthetics used as lotions, ointments or skin patches have also been found to be useful to control pain. Creams containing a substance found in hot peppers called capsaicin, can help relieve pain in certain disorders such as osteoarthritis or shingles.
How about non-drug pain treatments?
Transcutaneous electrical nerve stimulations – also know as Tens – has been found to be beneficial in some individuals with certain types of chronic pain.
This involves the application of a gentle electrical current transmitted to the muscles through electrodes placed on the skin surface.
It can be applied continuously or several times a day for short periods, depending on the needs of the person and their response to the treatment.
Deeper treatments using ultrasound can be beneficial but must be carried out by a qualified therapist. Acupuncture has been shown to help relieve pain although the exact mechanism by which it works is still unknown.
Cognitive approaches such as biofeedback, hypnosis and relaxation therapy are also important methods of controlling pain as is psychological support and counselling.