New Study Finds Antidepressants And Antipsychotics Can Be An Alternative To Opioids
Opioids have long been used for pain relief in emergency departments, especially in America. Paralleling these prescriptions has been a major opioid crisis in the US, which first began in the 90s and has lasted to this day. Many healthcare workers from all branches of the medical industry have looked towards alternatives to opioids to help reduce the national impact, and most recently it has been found that medications used as antidepressants and antipsychotics, could be a solution.
According to a new recently published study, these non-opioid medications, that are already available within emergency departments, could also provide pain relief. Akash Shanmugam, a medical student at the University of California, San Francisco (UCSF) and first author of the study, told the Guardian that the goal of this research was to “create a very targeted list for specific pain conditions” that can help physicians all over the country create new “toolboxes” for themselves to treat patients.
While opioids do have the reputation of reducing pain effectively, uneven prescriptions and the highly addictive nature of these drugs is what’s currently fueling the opioid epidemic in America.
The study also provided recommendations for the most common types of pain that patients come into the emergency department for such as abdominal pain, back pain, chest pain, headaches, etc.
Dr. Kathy LeSaint, an associate professor of emergency medicine at UCSF and fellow author of the study, agreed with Shanmugam regarding the fact that opioids do still have a place in modern medicine, but this study can hopefully lead to a place where it’s not creating addiction problems for patients looking for relief.
“The desire to reduce opioids shouldn’t come at the expense of under-treating pain.”
Dr. LeSaint also emphasized that even looking beyond concerns regarding opioid addiction and overdose, it’s integral in a general sense to have a variety of medications for pain available that will work from patient-to-patient.
“The enzymes that are responsible for metabolizing opioids can have different strengths in people,” LeSaint explained, pointing out that the variation is often genetic depending on what medications work for each patient.
The study examined all sorts of pain medications, starting with common ones like acetaminophen and ibuprofen. They also looked into drugs with “targeted applications” like ketamine, which is used as a common anaesthetic and showed potential for chest pain relief. SNRI (serotonin norepinephrine reuptake inhibitor) antidepressants showed promising results for back pain relief. Additionally, several kinds of antipsychotics could help with headache and abdominal pain.
Shanmugam pointed out that psychotropic medications have been used for a while for pain relief in addition to psychiatric symptoms. He gave the example of gabapentin and how it was initially approved to be used as a drug for epilepsy, but “now it’s used a lot for the management of neuropathic pain.”
He emphasized that the parts of psychotropic medications that make them effective for pain are quite complex, and their efficacy is likely connected to the fact that “neural circuits that create the sensation of pain are also involved in the emotional experience of pain, and the distress that pain produces for human beings.”
“In chronic pain conditions, the nervous system can become highly sensitive, and it’s thought that antidepressants and antipsychotics can maybe reduce this heightened sensitivity in the brain,” Dr. LeSaint added.
“Chronic pain is often linked to things like poor sleep, depression, anxiety, fatigue,” and medications that help people sleep better and experience less anxiety can also make managing pain easier to deal with.
Dr. LeSaint emphasized how doctors need to review the evidence and what occurs with the individual patient’s specific symptoms.
“Talking to them and asking about their prior experience with opioids prior to giving opioids can be really helpful in tailoring the pain regimen for that particular patient, for that particular pain syndrome,” Dr. LeSaint said.
According to Shanmugam, when physicians prescribe psychiatric medications specifically, it’s integral to make sure the patients understand it doesn’t mean the pain is mental.
“I’ve seen a lot of clinicians use the basic science approach of explaining that there’s a lot of overlap between the pain mechanisms and also the emotional understanding of pain, that really helps reassure patients.”
Eric Mastrota is a Contributing Editor at The National Digest based in New York. A graduate of SUNY New Paltz, he reports on world news, culture, and lifestyle. You can reach him at eric.mastrota@thenationaldigest.com.