Chapter 4

Pain Management Strategies: Some Uses of Antidepressant Medications and Non- Pharmacological Approaches

Kathy Sexton-Radek, Antoine Chami and Alissa Rubinfeld


It is estimated that some 25-30% of the population in the United States have experienced chronic pain. Worldwide, estimates reflect values of 35-40%. Chronic pain prevalence figures intensify the treatment approaches to care. Both pharmacological and non-pharmacological care is provided to address pain discomfort—oftentimes, at an individualized level. Relatively new strategies of prescribing additional pain management prescriptions of anti-depressant medications have enhanced the quality of care of the chronic pain patient. Sensory inputs from ascending pathways to the brain are targeted by pain medications. The common pathway to the cerebrum, at the periaqueductal gray which is largely noradrenergic and serotonergic, provides an additional platform to provide pharmacological treatment to the chronic pain patient. Anti-depressant medications act in many regions of the brain including the periaqueductal area. The resultant modulation of pain serves to also enhance the perception of pain relief from other pain medications. The adjuvant pain management treatment of anti-depressant medications is presented in terms of the types of chronic pain treated, the proposed mechanism of action of the antidepressant medications, and the other medications used in conjunction with anti-depressant medications.

Total Pages: 171-183 (13)

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