Serotonin-Norepinephrine Reuptake Inhibitors for Pain Control: Premise and Promise

Abstract

The precise mechanisms of pain perception and transmission in the central nervous system have not been fully elucidated. However, extensive data support a role for the monoamine neurotransmitters, serotonin and norepinephrine, in the modulation of pain. Experiments with animal models of pain indicate that noradrenergic interventions, and to a lesser extent serotonergic interventions, reduce pain-related behavior. This is supported by data from clinical trials in humans in which antidepressants have been shown to reduce pain and functional impairment in central and neuropathic pain conditions. These effects are particularly well-studied in trials with serotonin-norepinephrine reuptake inhibitors (SNRIs), which have provided a useful tool in the clinician’s arsenal, particularly considering the limitations of other classes of pain medications such as opioids, anti-inflammatories, and anticonvulsants (i.e., limited efficacy, safety and tolerability issues). Moreover, painful physical symptoms are frequently comorbid with major psychiatric disorders such as major depressive disorder and anxiety disorders. This paper reviewed and summarized the rationale and potential role of SNRIs for the control of pain including clinical and preclinical background. Currently evidence does not definitely support a role of the SNRIs, while limited data propose a putative promise of SNRIs in the treatment of pain related disorders including fibromyalgia and depressed patients with multiple somatic complaints. More researches are warranted to generalize currently available preliminary evidences.

Visceral Pain and Gastrointestinal Microbiome

“…Furthermore, LGG was found to alter the levels of brain neurotransmitters, like serotonin, noradrenaline, and dopamine which are known to be involved in pain modulation. 59 In a study by Kamiya et al, 60 treatment with live and killed Lactobacillus reuteri prevented the pain response to colorectal distension by decreasing of the dorsal root ganglion single unit activity to distension. In another study, L. reuteri was found to reduce sensation of pain via the enteric nerve in a model of visceral pain induced by colorectal distension.…”

Musculoskeletal Pain and Mental Agony Reacting to Ergonomic Risks in the Thai Informal Working Environment

“…Changes in mood (anxiety and burnout) are associated with the changes in serotonin and norepinephrine concentration in the brain regions. The dysregulation in one or both of these neurotransmitters may dampen peripheral pain signals and finally contribute to the frequent presence of MSP symptoms (Marks et al, 2009;Tops et al, 2007). According to De Heer et al (2014), anxiety and burnout facilitates the central modulation of the pain response in the areas of periaqueductal gray, amygdala, and hypothalamus.…”

Serotonin in Neurological Diseases

“…The TGVS transmitting migraine pain may be controlled by serotonergic neurons. 5-HT can modulate the trigeminal nerve function, as well as inhibit or promote the pain perception [18]. A decreased level of platelet 5-HT and its metabolite, N-acetylserotonin (NAS), during migraine activate TGVS by CSD [19].…”