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Anti-depressants for Back Pain and Neck Pain

Multi-faceted Pain Demands Multi-faceted Treatment

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As anyone who's suffered from a spinal condition knows, back and neck pain are rarely just back and neck pain. You may also feel fatigued or develop sleep disturbances. Your pain may spread from the physical to the mental and emotional. Anxiety, irritability, and depression are common if you have chronic pain, and this can certainly diminish your overall sense of well-being. That's why anti-depressants are a viable treatment option for back and neck pain.

Doctors prescribe anti-depressants to their back pain patients for a number of reasons—to reduce pain and muscle tension, help regain healthy sleep patterns, and of course, address the mental and emotional toll of pain. In most cases, doctors prescribe anti-depressants in lower doses to treat back pain than would be used to treat depression.

But the use of anti-depressants for spinal pain is a disputed subject because their analgesic—or pain—relieving-properties aren't fully understood. To help shed light on the confusion, the Cochrane Collaboration, a not-for-profit healthcare research organization, reviewed the results of 10 studies on the effectiveness of anti-depressants on back pain. The review, published in 2008, found no conclusive evidence that the medications provide any significant benefit for back pain sufferers.1

However, the Cochrane Collaboration suggests that anti-depressants may help alleviate pain associated with other conditions, such as musculoskeletal disorders. For instance, fibromyalgia, rheumatoid arthritis, spondylosis (also known as spinal osteoarthritis) have been found to respond particularly well to anti-depressants.

There are many types of anti-depressants. This article will describe 3 classes of anti-depressants that are commonly prescribed for back pain:

  • tricyclic anti-depressants (TCAs)
  • serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • selective serotonin reuptake inhibitors (SSRIs)

 Tricyclic Anti-depressants (TCAs)
Of all the classes of anti-depressants available, TCAs are considered the most effective for back pain.

Here's how TCAs work: When certain chemicals in your brain become imbalanced, you may experience pain and have difficulty sleeping. TCAs help regain balance by raising the levels of calming neurotransmitters—namely serotonin, norepinephrine, and dopamine—in your brain.

Examples of TCAs are listed below (the generic names are listed first, with a brand name example in parentheses):

  • Amitriptyline (Elavil)
  • Desipramine (Norpramin)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)

Side effects of TCAs include nausea, weight changes, drowsiness, dizziness, dry eyes and mouth, and constipation. If you experience more serious side effects, such as increased heart rate, sudden numbness or headache, or blurred vision, seek medical help immediately.

Updated on: 11/12/12
Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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