Off-label Antidepressant Use for Treatment and Management of Chronic Pain: Evolving Understanding and Comprehensive Review

AbstractPurpose of ReviewWhile clinicians have been using antidepressants for off-label indications in the treatment of chronic pain in recent years, newer studies have proven effectiveness and provided additional mechanistic understanding and defined potential adverse effects. As depression and chronic pain are frequently comorbid conditions, the use of antidepressants has allowed for treatment of both conditions concomitantly in the same patient population.Recent FindingsThe most commonly used antidepressants for chronic pain are tricyclic antidepressants (TCAs), though selective serotonin or noradrenaline reuptake inhibitors and other atypical antidepressants have been shown to be effective at treating chronic pain. In addition to neuropathic pain, bupropion has also demonstrated effectiveness in treating chronic pain caused by inflammatory bowel disease. Selective norepinephrine receptor inhibitors (SNRIs), including duloxetine, serve to suppress neuropathic pain by altering recovery of the noradrenergic descending inhibitory system in the spinal cord. While the direct mechanism of action is largely unknown, TCAs may suppress the noradrenergic descending inhibitory system to produce an antihyperalgesic effect.SummaryThe use of antidepressants offers alternative and adjunctive therapy options for patients suffering from chronic pain from various modalities. TCAs, mono-amine oxidase inhibitors, selective serotonin receptor inhibitors, SNRIs, and atypical antidepressants hav...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research

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ConclusionsPA activates PXR signalling and suppresses NF-κB signalling, consequently causing ameliorating inflammation. Results highlight the importance of PXR–NF-κB crosstalk in colitis and suggest a novel therapeutic reagent.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsThis study suggests that PLS exhibits anti-inflammatory action against intestinal damage by reducing inflammatory cell infiltration, oxidative stress, pro-inflammatory action of cytokines, and COX-2 expression in the inflamed colon. PLS shows therapeutic potential against inflammatory disorders like UC.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusions: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (rem...
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 12 October 2019Source: Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)Author(s): Q. Xu, M. Lv, Y. Xia, Y. Zhao, W. Zhang, Y. ChenAbstractA 42-year-old woman presented with a ten-day history of dysphagia, slight chest pain and occasional vomiting. With the performance of thoracic and abdominal enhanced computed tomography (CT) and upper gastrointestinal contrast, once esophageal cancer was suspected. Significant activity mass in esophagus and mediastinal lymph nodes could be found on the imaging of 18F-FDG PET/CT, which also supported malignancy. However, T...
Source: Revista Espanola de Medicina Nuclear e Imagen Molecular - Category: Nuclear Medicine Source Type: research
Publication date: Available online 10 October 2019Source: NeuroImageAuthor(s): Spurny B, Seiger R, Moser P, Vanicek T, M.B. Reed, Heckova E, Michenthaler P, Basaran A, Gryglewski G, Klöbl M, Trattnig S, Kasper S, Bogner W, Lanzenberger RAbstractNeural plasticity is a complex process dependent on neurochemical underpinnings. Next to the glutamatergic system which contributes to memory formation via long-term potentiation (LTP) and long-term depression (LTD), the main inhibitory neurotransmitter, GABA is crucially involved in neuroplastic processes. Hence, we investigated changes in glutamate and GABA levels in the brai...
Source: NeuroImage - Category: Neuroscience Source Type: research
Publication date: Available online 8 October 2019Source: NeuroImageAuthor(s): In-Seon Lee, Elizabeth A. Necka, Lauren Y. AtlasAbstractPain is a subjective, multidimensional experience that is distinct from nociception. A large body of work has focused on whether pain processing is supported by specific, dedicated brain circuits. Despite advances in human neuroscience and neuroimaging analysis, dissociating acute pain from other sensations has been challenging since both pain and non-pain stimuli evoke salience and arousal responses throughout the body and in overlapping brain circuits. In this review, we discuss these chal...
Source: NeuroImage - Category: Neuroscience Source Type: research
Conclusions: TR2 had a positive effect on the office workers' energy expenditure, blood parameters, depression, fatigue, and productivity. PMID: 31603033 [PubMed - as supplied by publisher]
Source: International Journal of Occupational Safety and Ergonomics - Category: Occupational Health Tags: Int J Occup Saf Ergon Source Type: research
“Once you learn the art of relaxation, everything happens spontaneously and effortlessly.” – Amma During hectic times, it’s tough to remember that relaxation is more than a luxury. In fact, humans need to relax to maintain balance in their lives. Work stress, family strife, and mounting responsibilities can exact a tremendous toll. Relaxing should be at the top of the list as a healthy coping measure and as a rewarding self-gift. Why do we so often neglect this healing self-care? Do you know the healthiest ways to relax your mind, body and soul? Perhaps the biggest obstacle to relaxing is that some ...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: Mental Health and Wellness Mindfulness Self-Help Source Type: blogs
Follow the current debate on “healthcare reform”–which has NOTHING to do with healthcare reform, but healthcare insurance reform, by the way–and you will hear comments about the escalating and uncontrolled cost of healthcare and how people need access to it. What you will NOT hear is that fact that, because the healthcare system fails to deliver genuine health, real health is actually quite easy, straightforward, and inexpensive–nearly free. We achieve a life of being Undoctored, not becoming a profit source for the healthcare industry, not being subjected to the predatory practices of Big P...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Undoctored Wheat Belly Lifestyle acid reflux anti-aging autoimmune blood sugar bowel flora cholesterol Dr. Davis energy Gliadin gluten gluten-free grain-free grains health healthcare Inflammation joint pain low-carb Source Type: blogs
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