SNRIs for Chronic Pain

Over the past few weeks, we have been looking at various medications that can help reduce the symptoms of anxiety for those suffering from an anxiety disorder.

In our last article, we looked at SNRIs, which are Selective Norepinephrine Reuptake Inhibitors.

Though SNRIs are unique in their ability to inhibit the reuptake of the neurotransmitter norepinephrine, SNRIs are similar to SSRIs  (Selective Serotonin Reuptake Inhibitors) as they also inhibit the absorption of serotonin, thus making more of it available in the brain.

Both SSRIs and SNRIs are used to treat depression and anxiety, as well as panic disorder, social anxiety, and social phobia amongst others. The majority of the time physicians will start a patient in need of an antidepressant with an SSRI due to the fact that most people tolerate them well with fewer side effects. However, in recent years, more and more physicians are prescribing SNRIs.

So why is this? Are SNRIs better?

Not necessarily, however, SNRI medications do have some advantages over SSRIs in that they have proven to be effective in treating other conditions that are not necessarily mental health issues, like chronic pain and nerve pain.

So let’s take a further look at some of the other conditions that SNRIs are sometimes used to treat.

Chronic Pain

When it comes to treating chronic pain, especially nerve pain, recent studies have found that SNRIs can help improve pain symptoms. In fact, several studies have shown that after a few weeks of treatment, the majority of people taking SNRIs for this condition, do notice a decrease in pain.

Though the pain-relieving mechanism of these medications isn’t entirely understood, it is generally believed that the effect is due to shared neurobiology and neuro-anatomy in the brain as that of depression and anxiety.

The SNRIs used to help treat chronic pain that is often accompanied by depression are venlafaxine (Effexor XR), duloxetine (Cymbalta, Drizalma Sprinkle), milnacipran (Savella) and desvenlafaxine (Pristiq).

Diabetic Neuropathy

SNRIs can also be beneficial in treating the pain associated with diabetic neuropathy.

Diabetic Neuropathy is nerve damage caused by diabetes that can lead to pain, ulcerations, and in some cases, amputation. Forutunately, SNRIs can help manage the pain in people with this condition.

Duloxetine, also known by its brand name Cymbalta, is an SNRI that is FDA to help relieve pain caused by diabetic neuropathy. In short-term clinical trials, duloxetine was more effective than a placebo.

SNRIs and sometimes SSRIs can also be used to help relieve pain caused by:

  • Arthritis
  • Nerve damage from diabetes (diabetic neuropathy)
  • Nerve damage from shingles (postherpetic neuralgia)
  • Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, radiculopathy)
  • Tension headache
  • Migraine
  • Facial pain
  • Fibromyalgia
  • Low back pain
  • Pelvic pain
  • Pain due to multiple sclerosis

Not only can an SNRI help with relieving pain, but it can also help relieve some of the depression that often comes along with it.

There is also evidence to support that the SNRIs venlafaxine and duloxetine are effective at relieving anxiety as well.

Though different SNRIs can be used off-label to treat a variety of mental and physical health conditions, the Food and Drug Administration (FDA) has specifically approved these SNRIs for the treatment of these conditions:

  • Desvenlafaxine (Pristiq)- Depression.
  • Duloxetine (Cymbalta) — Depression, and also approved to treat anxiety and certain types of chronic pain.
  • Levomilnacipran (Fetzima)- Depression.
  • Venlafaxine (Effexor XR) — Depression, and also approved to treat certain anxiety disorders and panic disorders.

Though SNRIs and SSRIs can both help in the treatment of anxiety and depression, SNRIs do have the advantage of helping those of us afflicted with chronic pain. However, ultimately the decision regarding the medication that would be best for you comes down to working with your doctor to find the best treatment for your particular mental and potentially, physical health conditions.

Though many find relief from their symptoms by taking an SSRI or an SNRI, sometimes in order for the medicines to work better, or to help target any residual anxiety or depression, it can be beneficial to add on another medication. When another medication is added for this purpose, it is called augmentation, and it can be very effective and may be worth discussing with your doctor.

In our next article, we will take a look at some common augmentation strategies for those who are responding well to an SSRI or SNRI but are experiencing unwanted side effects or could use a little more help in treating their symptoms.

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