Carlos Solis
Opioids do a good job at easing pain, but their wide use without careful attention to addiction risks helped trigger the U.S. opioid crisis that began in the 1990s. The study authors emphasize the goal isn’t to eliminate opioids entirely.
At the same time, clinicians need more tools because the best pain medicine often varies by a patient’s genetics, the type of pain, and the patient’s past experience with opioids, says Dr. Keti LeSent, an associate professor of emergency medicine at UCSF and a co-author of the paper.
What the researchers recommend for the most common pain types
The authors focused on the five pain syndromes most often seen in emergency departments: abdominal pain, back pain, chest pain, fractures, and headache. A few key takeaways:
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, showed potential to ease all the pain types they reviewed.
- Ketamine, used as an anesthetic, looked promising for chest pain.
- An SNRI, a class of antidepressants that blocks the reuptake of serotonin and norepinephrine, showed benefit for certain pain types.
- Several antipsychotic medications proved effective for headache and abdominal pain.
Why psychotropic drugs can reduce pain
Using psychotropic drugs to treat pain isn’t new. For example, gabapentin was first approved as a modestly effective anticonvulsant but later became widely used for neuropathic pain.
Different psychotropic drugs work in complex ways that researchers don’t fully understand, but their effectiveness likely stems from overlap between the neural pathways that produce pain sensations and the pathways that shape emotional responses to pain and suffering.
- Neurotransmitters such as dopamine, serotonin, norepinephrine, and glutamate regulate mood and also play roles in how pain arises.
- Gabapentin probably alters neurotransmitter release by affecting calcium channels.
- Antidepressants and antipsychotics change signal transmission more directly, helping to “reset” nervous-system activity in chronic conditions when the system becomes hypersensitive.
“In chronic pain, the nervous system can become highly sensitized, and antidepressants and antipsychotics may lower that heightened brain reactivity,” Dr. Keti LeSent explains.
Chronic pain often comes with sleep problems, depression, anxiety, and fatigue. Medications that improve sleep and mood can reduce how much pain a person experiences both physically and psychologically. That’s why psychotropic drugs can be useful as part of a broader pain-management plan.
A personalized approach and how to explain it to patients
LeSent stresses that clinicians should weigh the evidence while also considering each patient’s specific situation. Talking about the patient’s prior experience with opioids helps choose the right pain-control strategy for a particular pain syndrome.
Clinicians should also make clear to patients that prescribing psychotropic medications does not mean the pain is “just in their head.” These drugs target the same biological mechanisms that create pain sensations and the suffering that comes with them.
The study authors acknowledge that opioids still have a role in medicine, especially for short-term relief of severe pain. A primary task for clinicians is to reduce the risk of addiction while ensuring patients receive adequate pain control.
Based on reporting in The Guardian
