scholarly journals Treating Chronic Pain with SSRIs: What Do We Know?

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Elias Patetsos ◽  
Emilia Horjales-Araujo
Keyword(s):  
Chronic Pain ◽  
Clinical Trials ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tricyclic Antidepressants ◽  
Drug Class ◽  
Secondary Effects ◽  
Monoamine Neurotransmitter ◽  
Chronic Pain Patients ◽  
Chronic Pain Conditions ◽  
Pain Patients

Serotonin is a monoamine neurotransmitter that plays a major role in both nociception and mood regulation. Alterations in the 5-hydroxytryptophan (5HT) system have been reported in chronic pain patients. In recent years, Selective Serotonin Reuptake Inhibitors (SSRIs) have been suggested as an alternative treatment for chronic pain due to the fact that they are better tolerated presenting less secondary effects than other antidepressants such as tricyclic antidepressants. Although several clinical trials have been published, the effectiveness of SSRI as treatment for pain conditions is inconclusive. This review aims to summarise what is known, regarding the effectiveness of SSRI as a treatment for chronic pain conditions in adults. A total of 36 studies involving a total of 1898 participants were included in this review. Of the 36 trials included in the review, 2 used zimelidine as treatment, 3 used escitalopram, 4 used fluvoxamine, 4 used sertraline, 6 used citalopram, 8 used paroxetine, 9 used fluoxetine, and one used both citalopram and paroxetine. Because the trials included in this review are quite heterogeneous, only qualitative analyses were performed. SSRI seems to have an effect on most of chronic pain conditions; however, further clinical trials with good methodology leading to low risk of bias are needed in order to conclude once and for all the effect of this drug class as treatment for chronic pain conditions.

Assay sensitivity in clinical trials with chronic pain patients

Pain ◽  
2012 ◽  
Vol 153 (6) ◽  
pp. 1136-1137
Author(s):  
Rolf-Detlef Treede
Keyword(s):  
Chronic Pain ◽  
Clinical Trials ◽  
Assay Sensitivity ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Susanne Becker ◽  
Edita Navratilova ◽  
Frauke Nees ◽  
Stefaan Van Damme
Keyword(s):  
Chronic Pain ◽  
Brain Activity ◽  
Pain Processing ◽  
Cellular Mechanisms ◽  
Related Information ◽  
Current State ◽  
Chronic Pain Patients ◽  
Fear And Anxiety ◽  
Chronic Pain Conditions ◽  
Pain Patients

Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies.

scholarly journals The Role of the Kynurenine Signaling Pathway in Different Chronic Pain Conditions and Potential Use of Therapeutic Agents

2020 ◽  
Vol 21 (17) ◽  
pp. 6045 ◽  
Author(s):  
Filip Jovanovic ◽  
Kenneth D. Candido ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Chronic Pain ◽  
Signaling Pathway ◽  
Peripheral Tissues ◽  
Chronic Pain Patients ◽  
The Central Nervous System ◽  
Chronic Pain Conditions ◽  
Pain Patients ◽  
Potential Use

Tryptophan (TRP) is an essential, aromatic amino acid catabolized by indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO) enzymes into kynurenine. The IDO enzyme is expressed in peripheral tissues and the central nervous system. Another enzyme of interest in the kynurenine signaling pathway is kynurenine 3-monooxygenase (KMO). The purpose of this review is to discuss the role of TRP and the kynurenine signaling pathway in different chronic pain patients. The IDO-1, IDO-2, and KMO enzymes and the kynurenine metabolite have been shown to be involved in the pathogenesis of neuropathic pain and other painful conditions (migraine, cluster headache, etc.) as well as depressive behavior. We highlighted the analgesic potential of novel agents targeting the enzymes of the kynurenine signaling pathway to explore their efficacy in both future basic science and transitional studies. Upcoming studies conducted on animal models will need to take into consideration the differences in TRP metabolism between human and non-human species. Since chronic painful conditions and depression have common pathophysiological patterns, and the kynurenine signaling pathway is involved in both of them, future clinical studies should aim to have outcomes targeting not only pain, but also functionality, mood changes, and quality of life.

scholarly journals Music-induced analgesia in chronic pain conditions: a systematic review and meta-analysis

2017 ◽  
Author(s):  
Eduardo A. Garza-Villarreal ◽  
Victor Pando ◽  
Peter Vuust ◽  
Christine Parsons
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Sample Size ◽  
Meta Analysis ◽  
Measurement Instrument ◽  
Music Intervention ◽  
Post Intervention ◽  
Chronic Pain Patients ◽  
Chronic Pain Conditions ◽  
Pain Patients

AbstractMusic is increasingly used as an adjuvant for chronic pain management as it is not invasive, inexpensive, and patients usually report positive experiences with it. However, little is known about its clinical efficacy in chronic pain patients. In this systematic review and meta-analysis, we investigated randomized controlled trials (RCTs) of adult patients that reported any type of music intervention for chronic pain, chosen by the researcher or patient, lasting for any duration. Searches were performed using PsycINFO, Scopus and PubMed for RTCs published until the end of May 2016. The primary outcome was reduction in self-reported pain using a standardized pain measurement instrument reported post-intervention. The secondary outcomes were: quality of life measures, depression and anxiety measures, among others. The study was pre-registered with PROSPERO (CRD42016039837) and the meta-analysis was done using RevMan. We identified 768 titles and abstracts, and we included 14 RTCs that fulfilled our criteria. The sample size of the studies varied between 25 and 200 participants. We found that music reduced chronic pain, and depression, with higher effect size on pain and depression. We also found music had a higher effect when the participant chose the music in contrast with researcher-chosen music. The sample size of RCTs was small and sometimes with different outcome measures. Our analysis suggests that music may be beneficial as an adjuvant for chronic pain patients, as it reduces self-reported pain and its common co-morbidities. Importantly, the analgesic effect of music appears higher with self-chosen over researcher-chosen music.

scholarly journals Pain as an object of research, treatment, and decision-making

2010 ◽  
Vol 7 (13) ◽  
Author(s):  
Lise Kirstine Gormsen
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Social System ◽  
Medical Doctor ◽  
Pain Research ◽  
Professional Norms ◽  
The Social ◽  
Chronic Pain Patients ◽  
Chronic Pain Conditions ◽  
Pain Patients

This essay is a reflection on my professional norms when I do pain research, treat pain patients, and communicate with the social system. Being both a medical doctor and a clinical researcher, I daily have to combine what I see as arbitrary rationalities in my approach to pain. The reason is that pain research is often conducted within a theoretical framework that mainly understands pain as a physical or biomedical phenomenon even though a broader and more precise perspective on pain exists - and is often used when physicians treat patients. It is of interest to see how easily doctors use different concepts of pain when they conduct biomedical research with advanced equipment and standardized tools with one hand, and with the other hand talk to patients, trying to focus on their needs and helping them cope with their pain using a very broad perceptive of pain. This dilemma of acting both as a researcher and a clinical doctor is not often discussed or reflected upon by doctors. An explanation could be the focus on productivity and efficiency that rules the everyday life of most doctors as opposed to a focus on reflection, concepts, and values in pain medicine. The focus of this essay is therefore to describe,reflect, and elaborate on the differences of pain as an object of research, treatment, and decision-making. In other words, to reflect upon the ambiguous practice doctors engage in when doing pain research and treating chronic pain patients. Furthermore, this essay may contribute to our understanding of why decisions on eligibility in the social system are made without adequate documentation of patients’ chronic pain conditions.

scholarly journals Stereotyped perceptions of chronic pain

2010 ◽  
Vol 7 (13) ◽  
Author(s):  
Marie Østergaard Møller
Keyword(s):  
Chronic Pain ◽  
Social System ◽  
Pain Medicine ◽  
Pain Research ◽  
Professional Norms ◽  
The Social ◽  
Chronic Pain Patients ◽  
The Everyday ◽  
Chronic Pain Conditions ◽  
Pain Patients

This essay is a reflection on my professional norms when I do pain research, treat pain patients, and communicate with the social system. Being both a medical doctorand a clinical researcher, I daily have to combine what I see as arbitrary rationalities in my approach to pain. The reason is that pain research is often conducted within a theoretical framework that mainly understands pain as a physical or biomedical phenomenon even though a broader and more precise perspective on pain exists - and is often used when physicians treat patients. It is of interest to see how easily doctors use different concepts of pain when they conduct biomedical research with advanced equipment and standardized tools with one hand, and with the other hand talk to patients, trying to focus on their needs and helping them cope with their pain using a very broad perceptive of pain. This dilemma of acting both as a researcher and a clinical doctor is not often discussed or reflected upon by doctors. An explanation could be the focus on productivity and efficiency that rules the everyday life of most doctors as opposed to a focus on reflection, concepts, and values in pain medicine. The focus of this essay is therefore to describe,reflect, and elaborate on the differences of pain as an object of research, treatment, and decision-making. In other words, to reflect upon the ambiguous practice doctors engage in when doing pain research and treating chronic pain patients. Furthermore, this essay may contribute to our understanding of why decisions on eligibility in the social system are made without adequate documentation of patients’ chronic pain conditions.

Pain Influences Several Levels of Attention

2005 ◽  
Vol 16 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Astrid von Bueren Jarchow ◽  
Bogdan P. Radanov ◽  
Lutz Jäncke
Keyword(s):  
Chronic Pain ◽  
Divided Attention ◽  
Covert Attention ◽  
Attention Task ◽  
Attentional Deficits ◽  
Control Subjects ◽  
Chronic Pain Patients ◽  
Divided Attention Task ◽  
Pain Stimuli ◽  
Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

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