Au-delà De La Dépression, Des Antidépresseurs Pour Traiter La Douleur Chronique

Antidepressants were originally designed and marketed to treat depression and anxiety disorders, but they are also an off-label option that should be considered by clinicians in specialties other than psychiatry, particularly for the treatment of chronic pain. Chronic pain is considered one of the most costly and disabling medical conditions. There are many different treatment options available for patients that suffer from chronic pain, ranging from pharmacological therapy to surgical interventions. Antidepressants are used to treat a variety of chronic pain conditions including peripheral neuropathy, headache, and more recently, fibromyalgia. In this regard, recent studies have proven their effectiveness, and given further understanding of their mechanisms, drug-drug interactions, and adverse effects. The first antidepressants to have been used in this indication are the tricyclic antidepressants. They remain benchmark products, even though newer antidepressants, such as serotonin and norepinephrine reuptake inhibitors, venlafaxine, milnacipran and duloxetine, or other atypical antidepressants, such as bupropion, are increasingly used, in part because of their better tolerability. Selective serotonin reuptake inhibitors, on the other hand, appear to have no analgesic effects. Prescription of antidepressants offers an alternative and adjunct therapeutic option for patients with chronic pain of various modalities. It is also hoped that treating chronic pain with antidepressants could lead to a decrease in the use of opioid analgesics and also improve many of the concurrent psychiatric conditions associated with chronic pain. Further evidence-based research is still needed to establish better safety profiles and efficacy of antidepressant use in patients with chronic pain. (C) 2021 Elsevier Masson SAS. All rights reserved.