Antidepressants to Treat Back Pain

Doctors and researchers have long observed, if not fully understood, an association between emotional problems and chronic pain conditions. People who are in a more healthy emotional state of mind seem to either have a high pain tolerance or to be less likely to suffer from chronic pain conditions. People suffering from anxiety, depression, and in general a less stable health have been more likely to develop degenerative conditions such as arthritis, fibromyalgia, and back pain. The medical literature also has ample evidence that certain drugs whose primary purpose is to treat mood also have the purpose of treating pain conditions related to the nerves and other musculoskeletal conditions. The drugs most frequently for pain relief, other than analgesics (NSAIDS, steroids, Opioids), include Anticonvulsants and Antidepressants.

Today, there are first generation and second generation medications available to treat mood disorders such as anxiety disorders, and major depression. Today, the second generation drugs are being prescribed most often to more effectively treat emotional disorders while the first generation drugs remain in favor for treating certain chronic pain conditions. These second generation antidepressants seem to be effective in treating pain in patients with chronic pain and mood disorders even when the patient's mood disturbance isn't improved. These medications have also been show to be helpful in treating chronic pain even in patients who don't have depression or another mood disorder.

The first generation tricyclic antidepressants have been shown to be more effective in treating neuropathic pain than the second generation anti-depressants. Older generation tricyclic antidepressants include amitryptyline, desipramine, duloxetine, and nortryptiline.

Patients taking tricyclics for pain take a lower dose than patients taking them to treat mood disorders.

These medications may be more effective in treating pain relating to nerve disease or nerve radiculopathy than in treating pain condition that involve systemic diseases and degenerative joint disease. Chronic pain conditions relating to the nerves that may respond well to tricyclic antidepressants include back pain with radiculopathy, spinal nerve compression, diabetic neuropathy, and shingles. These drugs may also aid people who have difficulty getting to and sustaining sleep due to chronic pain. Because these medications may cause drowsiness, they should be taken within an hour of sleep.

Like most other drugs that treat mood disorders, these drugs may take a while to build up in a patient's system to have the desired effect. Often, these medications may take two to three weeks to have their desired effect of treating nerve pain. Patients should be careful with beginning and ending taking these medications, as suddenly stopping their delivery to the body may cause negative side effects or a reoccurrence of the symptoms of the chronic pain condition. Again, patients with chronic pain should be patient with giving this medication a chance to work, as some patient may go as long as 8 weeks before they begin to feel some pain relief.

Complications and Side Effects: The most common side effects of tricyclic antidepressants to treat back pain include:
  • Constipation
  • Dizziness
  • Drowsiness
  • Dry Mouth. Dry mouth is a common symptom, especially when waking in the morning.
  • Headache
  • Sun sensitivity
  • Weight Gain
Sun sensitivity: Some people who take tricyclic antidepressants develop over-sensitivity to the sun, a condition known as photosensitivity (phototoxic reaction). Symptoms of photosensitivity may develop redness, hives, and tenderness to areas of skin which have has exposure to sunlight.

Some antidepressants reduce pain symptoms by affecting the levels of the neurotransmitters norepinephrine and serotonin in the brain. Cymbalta is one such antidepressant. In a recent study, 401 patients with lower back pain showed significant improvements in their symptoms following 12 weeks of treatment with Cymbalta.