Replacing Opiates with Antidepressants to Successfully Treat Nerve Pain

Patients who suffer from Neuropathic pain, or pain that results from nerve damage often look far and wide for effective pain relief. This is because the pain can quickly become a person’s main focus, replacing anything else the mind typically focuses on. Nerve pain is typically a result of some type of tissue injury which causes damage to a person’s nerves. The damaged nerves then send faulty messages to the pain centers located in the brain.

Causes of Nerve Pain

Patients seem to each have their own unique descriptions of what nerve pain feels like. The most commonly used words include burning, stabbing, shooting, and electric shock. Just as there are many different descriptions of this type of pain, there are also many levels of pain that individuals feel. Some of the most common causes of nerve pain include:

  • Multiple Sclerosis
  • Chemotherapy
  • Amputation
  • Diabetes
  • HIV infection
  • Shingles

With so many different causes and levels of pain that are seen in patients, doctors may worry about over-prescribing medications, as this type of pain does not respond well to regular pain treatments. When options such as massage therapy, counseling, acupuncture and physical therapy do not give the patient the relief they are seeking, many doctors turn to opioids to lessen the waves of pain.

Problems With Opioid Prescriptions and Nerve Pain

Though studies show that certain opioids can be used effectively to manage chronic pain that comes from nerve damage, negative side effects may also offset this success. Patients who are on a regimen of high-dose opioids frequently experience personality changes, a rise in both depression and confusion and marked restlessness. As a patient nears the end of dosage time, the pain that was blocked by the opioid prescription may seem worse than it was before the medication as the patient now feels withdrawal symptoms too. This chemical dependency may allow the patient to continue with everyday routines, but frequently leads to yet another medical condition known as opioid-induced hyperalgesia. In essence, patients who have had long-term exposure to opioids may begin to find that they become more sensitive, or feel even more pain than what was being caused by the nerve damage.
In-Office dispensing is one of the most highly recommended ways for physicians to track not only the amount and effectiveness of opiates prescribed for nerve pain. It also allows more accurate charting of pain levels, possible personality changes and the frequency of requests for increased dosage. All too frequently, there is little or no communication between a traditional pharmacy and the prescribing physician. Taking the steps necessary to set up in-office medication dispensing means more immediate help for each patient combined with the ability to be quickly alerted should the patient begin to show signs of hyperalgesia.

Possibility for Opiate Addiction

According to drugabuse.gov, there were 245 million opioid prescriptions filled by pharmacies in the United States. Even though over 60% of these prescriptions were to be taken for less than 3 weeks, over 9.6 million adults were refilling prescriptions for long-term pain therapy.

Because opioids work mainly in the reward center of the brain, patients often feel a sense of euphoria and well-being as they experience the desired pain relief. The brain then begins to crave not only relief from pain, but also the high feeling as well. After months of being exposed to an opioid, increasing doses frequently lead to opiate addiction.

Antidepressants May Curb Both Nerve Pain and Addiction

Recent studies have found that certain antidepressants may be effective in treating neuropathic pain. Tricyclic antidepressants have been found to provide the greatest pain relief for patients who have long-term neuropathic pain. Instead of attaching to the pain receptors in the brain, as opioids do, antidepressants work by muting the pain signals that are sent to the brain. Tricyclic antidepressants are, however, not without side effects. Patients should be alerted to the fact that blurred vision, dizziness, an upset stomach, and constipation may be expected.
Another type of antidepressants is also showing promise with reference to nerve pain. SNRI’s may not be quite as effective as Tricyclic antidepressants, but they have fewer unpleasant side effects to worry about.

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