Anti-psychotics for chronic pain, fibro, and central sensitization syndrome

[drusso]

This is could be a game-changer: It is also cognitively compatible with the dominant narrative that chronic pain patients are crazy.

How much anti-psychotics are you RX-ing your practice for chronic pain?

A Systematic Review of Atypical Antipsychotics in Chronic Pain Management: Olanzapine Demonstrates Potential in Central Sensitization, Fibromyalgia, and Headache/Migraine

Jimenez, Xavier, F., MD, MA; Sundararajan, Tharani, MD; Covington, Edward, C., MD

The Clinical Journal of Pain: June 2018 - Volume 34 - Issue 6 - p 585–591
doi: 10.1097/AJP.0000000000000567
Review Articles

• Abstract
• Author Information

Introduction: Many psychopharmacologic agents are used as primary or adjuncts in pain management. Atypical antipsychotics (AAs) have also been used as adjuncts in pain management regimens in a variety of manners; however, their efficacy in this capacity is unclear.

Methods: A systematic review of all studies examining AA use for pain was conducted. Three literature databases were utilized to search for word combinations of “pain” and a variety of commonly prescribed AAs ie, (olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone, clozapine, paliperidone, iloperidone, lurasidone). Articles chosen for review included retrospective analyses, randomized control trials, and case series/reports. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram illustrates the study selection process.

Results: Olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone are the only AAs with published studies in pain management. Among these, olanzapine and quetiapine have the most studies (11 and 6, respectively). Olanzapine shows preliminary and consistent efficacy in fibromyalgia and headache/migraine, although only 1 study was a randomized controlled trial with level I evidence of efficacy. Other AAs eg, (quetiapine) fail to demonstrate efficacy in pain syndromes and/or lack robust study designs.

Conclusions: Few studies have been conducted to evaluate the analgesic effects of AAs. The collective findings of multiple studies evaluating olanzapine in pain syndromes suggest a high, yet preliminary level of evidence of efficacy, warranting prospective studies in various pain syndrome contexts. Pharmacological mechanisms of AA action are elaborated, and the findings of this review are discussed. Risk and benefits of using AAs in chronic pain are described, and investigational implications and future directions are explored.

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[lobelsteve]

If considered doing this. A little risperdal in my bloody mary every night....

Would make seeing all those patients seem easier.

 

[Ducttape]

And this “study” is different from all those other GIGO studies you decried, um, how?

 

[drusso]

And this “study” is different from all those other GIGO studies you decried, um, how?

Not at all except it comports with the current zeitgeist, dominant narrative, for treating pain-addicts.

 

[Ducttape]

I liked your post because you are consistent. Sometimes it’s good to be predictable...

Not so sure I agree with anti-psychotics and other psych meds for pain either...

 

[pmrmd]

No anti-psychotics without psychosis.


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[Orin]

I'll use them for sleep/nausea issues. I rarely sneak them onto a complex fibromyalgia patient.

I think of it as treating chronic pain as a sensory hallucination...

Seriously though, there are many pre-clinical and clinical studies showing interactions of the dopaminergic system, which most antipsychotics target, with opioid-mediated analgesia. Lets use all the tools we have.

I'd rather add a little olanzapine or quetiapine than tramadol or a full opioid agonist.

 

[ziggyziggy]

Conclusions: The collective findings of multiple studies evaluating olanzapine in pain syndromes suggest a high, yet preliminary level of evidence of efficacy, warranting prospective studies in various pain syndrome contexts.

There in lies the problem -the premise that collective finding of multiple studies produces something spectacular.

If this study has any value in central sensitization, then we would not be seeing psychiatric patients with chronic pain.

Again, association vs causation.