Can antidepressants be used for arthritis pain?

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by Drugs.com

Antidepressants can help lessen symptoms of arthritis pain, depression due to pain, and provide a more restful sleep in many people.

Pain is hard on your body and mind. Changes in your normal daily routine due to pain can lead to frustration and even depression. In fact, 20% of people with chronic pain are also depressed. Plus, the inability to move without pain can make orthopedic treatments -- including physical therapy and daily exercise -- difficult to tolerate and slow down recovery.

Common antidepressants used for orthopedic pain relief include:

  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR).
  • Tricyclic antidepressants (TCAs) like amitriptyline and nortriptyline (Pamelor). Drowsiness and anticholinergic side effects can be a complicating factor, particularly for older patients.

    • Select warnings with antidepressants:

    Be aware that antidepressants can lead to thoughts about self-harm and suicide in some patients, especially in teens, so careful monitoring is warranted. A Boxed Warning for this effect is found on all antidepressant package inserts.

  • View this example antidepressant Boxed Warning for suicidal thought and behaviors on the Prozac package insert.

    • Have your doctor or pharmacist check for drug interactions anytime a new medicine is started, a dose is changed or you stop treatment. Antidepressants are notorious for numerous and serious drug interactions.

  • Review drug interactions for medicines

    • In addition to prescribed physical therapy and exercise, drug therapy for orthopedic conditions can relieve the pain, swelling and paresthesias (tingling or numbing sensation) due to various conditions, such as:

  • Bone fractures
  • Torn ligaments or neuropathy
  • Osteoarthritis or degeneration of the knee, spine, or hip
  • Paget's disease
  • Rheumatoid arthritis
  • Osteoporosis

    • What else can I use to treat my arthritis pain?

    Based on your type of pain, your doctor can recommend the best treatment option. For pain that is due to tissue or bone damage (nociceptive pain) with inflammation, NSAIDs or acetaminophen may be the best option.

    For pain that originates in the nerves (neuropathic pain), antidepressants, antiseizure or topical products like capasicin may be recommended. Combination therapy with two treatments from different classes is common.

    Physical therapy and daily exercise are usually suggested to help strengthen muscles and joints to help prevent further injury. Ask your doctor what type of exercise you should engage in.

    Talk therapy (cognitive behavioral therapy) may be advised in some circumstances.

    Table 1: Treatment Options for Arthritis or Orthopedic Pain

    Drug or Treatment Class Example Products
    Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • aspirin
  • ibuprofen (Advil, Motrin IB)
  • naproxen (Aleve)
  • diclofenac (Voltaren)
  • meloxicam (Mobic)
  • celecoxib (Celebrex)
    		•
    Topical NSAIDs
  • diclofenac topical 2% solution (Pennsaid) - for use only on the knees
  • diclofenac transdermal (Flector Patch)
  • diclofenac topical 1% (Voltaren Arthritis Pain Gel) - available over-the-counter (OTC)
    		•
    Topical capsaicin
  • Zostrix
  • Capzasin-HP
  • Icy Hot Arthritis Therapy
  • Salonpas
  • Qutenza (requires a prescription)
    		•
    Acetaminophen
  • Tylenol products, generics, store brands (may not be a good 1st line treatment if inflammation a significant component or at risk for liver toxicity)
    		•
    Antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta). FDA-approved for chronic muscle or joint pain (such as low back pain and osteoarthritis pain) and fibromylagia.
  • Tricyclic antidepressants like amitriptyline and nortriptyline (Pamelor).
    		•
    Anticonvulsants
  • pregabalin (Lyrica, Lyrica CR)
  • gabapentin (Gralise, Horizant, Neurontin)
  • topiramate (Topamax)
  • carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
  • oxcarbazepine (Trileptal)
    		•
    Corticosteroids (glucocorticoids)
  • prednisone
  • methylprednisolone
  • triamcinolone (brand example: Zilretta)
  • dexamethasone
    		•
    Muscle relaxants
  • cyclobenzaprine (Amrix) - short-term use only (2-3 weeks)
  • tizanidine (Zanaflex)
  • metaxalone (Skelaxin)
  • methocarbamol (Robaxin)
  • baclofen
  • orphenadrine ER

    • Note: carisoprodol (Soma) is no longer recommended for use by many clinicians due to high rates of physical dependence and withdrawal side effects.

    Long-term of muscle relaxants questionable due to effectiveness. Pain relief in acute muscle spasms may be more related to sedative effects.
    Viscosupplementation
  • hylan G-F 20 (Synvisc, Synvisc-One)
  • hyaluronan (Hymovis, Orthovisc, Monovisc)
  • sodium hyaluronate (Durolane, Euflexxa, Gelsyn-3, Hyalgan, Supartz, Supartz FX)
    		•
    Opioid pain relievers
  • Not recommended first-line for long-term use in chronic non-cancer pain.
  • Use only when the benefits outweigh the potential risks, and other treatment option have failed.
  • If used, typically combined with non-opioid treatments and physical therapy and use at lowest possible dose.
  • Monitor carefully for risk of abuse.
    		•

    This is not all the information you need to know about antidepressants or other treatments for pain. This information does not cover the full information for safe and effective use and does not take the place of your doctor’s directions. Review the full product information you are given and discuss this information and any questions you have with your doctor or other health care provider.

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