Psychiatry - December 2008 - (Page 16)

The Interface (paroxetine, citalopram) or lacked any efficacy at all (fluoxetine). In this article, we review these various medications and offer an interpretive comparison, as there are few head-tohead comparison studies. INTRODUCTION Pain complaints, which emerge in both psychiatric and primary care settings, are a costly medical phenomenon. According to Jackson and St. Onge, the management of pain disorders in the US exceeds $100 billion annually, which includes medical care, workers compensation, and lost work productivity.1 This estimate is echoed by the American Pain Society.2 While lower back pain appears to be the most prevalent pain disorder,2 pain encompasses a number of different syndromes, including neuropathic pain. In this overview article, we have elected to focus specifically on neuropathic pain syndromes and will summarize the recent review articles in this area with regard to the use of antidepressants. THE WORKING DEFINITION OF NEUROPATHIC PAIN Pain, Pain, Go Away: Antidepressants and Pain Management by Randy A. Sansone, MD, and Lori A. Sansone, MD Psychiatry (Edgemont) 2008;5(12):16–19 This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care—two fields that are inexorably linked. Neuropathic pain is a subcategory of the larger group of pain syndromes and is characterized by (a) chronic pain, (b) various heterogeneous diagnoses (e.g., diabetic peripheral neuropathy, post-herpetic neuralgia, central post-stroke pain, phantom limb pain), and (c) differing etiologies.3 In addition, within a specific diagnosis, there is notable variability in the presentation as well as the characteristics of the experienced pain. ABSTRACT Pain, including neuropathic pain, is a relatively common complaint in various clinical settings. Several antidepressants have been efficacious in the management of chronic neuropathic pain, including the 16 Psychiatry 2008 [ V O L U M E 5, NUMBER tricyclic antidepressants (particularly the tertiary-amine subtypes, such as amitriptyline, doxepin, and imipramine) as well as venlafaxine, bupropion, and duloxetine. The selective serotonin reuptake inhibitors have either been less robust 12, DECEMBER] EPIDEMIOLOGICAL ASPECTS OF NEUROPATHIC PAIN According to Wolfe and Trivedi, about 1.5 percent of the US population is affected by neuropathic pain.4 This prevalence rate is reflected in healthcare costs. For example, in a 16

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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