Antipsychotics for acute and chronic pain in adults

Seidel, Stefan; Aigner, Martin; Ossege, Michael; Pernicka, Elisabeth; Wildner, Brigitte; Sycha, Thomas

doi:10.1002/14651858.cd004844.pub3

Cited by 44 publications

(18 citation statements)

References 44 publications

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“…Heightened sensitivity to emotional pictures and electrical stimulations cannot be explained away by a non-specific attention deficit or general deficit because both should have produced the opposite pattern of results. An effect of antipsychotic drugs also seems unlikely given the studies suggesting that pain perception is similar in treated and non-treated patients 14 16 26 , that emotional processing is normalized rather than worsened by antipsychotics 27 , and that antipsychotics are analgesic 28 . However, we cannot rule out the possibility that the response to stimulations was dampened on a subjective level by the intake of antipsychotics.…”

Section: Discussionmentioning

confidence: 99%

Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia

Duval

Goumon

Kemmel

et al. 2016

Sci Rep

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Patients with schizophrenia have often been described as insensitive to nociceptive signals, but objective evidence is sparse. We address this question by combining subjective behavioral and objective neurochemical and neurophysiological measures. The present study involved 21 stabilized and mildly symptomatic patients with schizophrenia and 21 control subjects. We applied electrical stimulations below the pain threshold and assessed sensations of pain and unpleasantness with rating scales, and Somatosensory Evoked Potentials (SEPs/EEG). We also measured attention, two neurochemical stress indices (ACTH/cortisol), and subjective VEPs/EEG responses to visual emotional stimuli. Our results revealed that, subjectively, patients’ evaluations do not differ from controls. However, the amplitude of EEG evoked potentials was greater in patients than controls as early as 50 ms after electrical stimulations and beyond one second after visual processing of emotional pictures. Such responses could not be linked to the stress induced by the stimulations, since stress hormone levels were stable. Nor was there a difference between patients and controls in respect of attention performance and tactile sensitivity. Taken together, all indices measured in patients in our study were either heightened or equivalent relative to healthy volunteers.

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Section: Discussionmentioning

confidence: 99%

Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia

Duval

Goumon

Kemmel

et al. 2016

Sci Rep

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“…Now that second generation (atypical) antipsychotics, are more widely used and available, the use of antipsychotics in the treatment of patients with pain symptoms is being revisited for treatment of pain and headache in adults. This is because of their multiple mechanisms of action and evidence of efficacy for treating many co-morbidities associated with pain including insomnia, refractory depression, and anxiety [139][140][141][142]. Atypical anti-psychotics affect many receptors that may modulate pain including 5-HT receptor agonism and antihistaminic, anti-alpha adrenergic, and anticholinergic activity.…”

Section: Antipsychoticsmentioning

confidence: 99%

Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders

et al. 2020

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Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.

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“…The effect of antipsychotics has been studied in the treatment of headaches, post-herpetic neuralgia, trigeminal neuralgia, and fibromyalgia [3]. While antipsychotics showed some potential for analgesic properties, their major adverse reactions such as extrapyramidal symptoms (acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia), anticholinergic effects, and prolactin elevation are associated with the limitation of their use, especially in the use of typical antipsychotics (the first generation antipsychotics) [345].…”

mentioning

confidence: 99%

“…While antipsychotics showed some potential for analgesic properties, their major adverse reactions such as extrapyramidal symptoms (acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia), anticholinergic effects, and prolactin elevation are associated with the limitation of their use, especially in the use of typical antipsychotics (the first generation antipsychotics) [345]. Nowadays, atypical antipsychotics, also referred to as second generation antipsychotics, which are known to have fewer extrapyramidal side effects and additional benefits, are available.…”

mentioning

confidence: 99%

The role and position of antipsychotics in managing chronic pain

Kim

2019

Korean J Pain

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Antipsychotics for acute and chronic pain in adults

Cited by 44 publications

References 44 publications

Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia

Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia

Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders

The role and position of antipsychotics in managing chronic pain

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