What is the best antidepressant for pain

Treatment of pain

Painkiller (Analgesics) are by far the top of the most frequently prescribed drugs. Many painkillers not only have an analgesic effect, they also dampen the sensations in the pain-evaluating areas of the limbic system. They are divided into strong pain relievers and weak to moderate pain relievers.

The basis of a drug-based pain therapy is the step-by-step plan of the World Health Organization (WHO): Painkillers with weak to moderately effective effects are the first level drugs. Painkillers of the 2nd level are the weak opioid analgesics, painkillers of the 3rd level are the opioids. The doctor must select analgesics and supportive drugs according to the type of pain.

Weak to moderately effective pain relievers

These are non-opioid analgesics. They have an analgesic and anti-inflammatory effect by inhibiting the formation of prostaglandin, a substance produced by the body that is involved in the development of pain, fever and inflammation. In addition, they seem to normalize the increased sensitivity of nerve endings (nociceptors) through other mechanisms. They are divided into the following groups:

Salicylic acid derivatives (e.g. acetylsalicylic acid)

They work very quickly against pain, but often cause stomach upset, heartburn and bleeding from the stomach lining. In addition, dizziness, ringing in the ears, nausea and vomiting can occur if these are taken in high doses over a long period of time.

Anillin derivatives (e.g. paracetamol or phenacetin)

Paracetamol and phenacetin have only weak pain relieving and anti-inflammatory effects. Paracetamol has a rapid antipyretic effect and is better tolerated than phenacetin. It is therefore also contained in "feverish juices" for children. However, in high doses it can damage the liver. Therefore, no more than 6 to 8 tablets containing 500 milligrams of paracetamol should be taken per day. It can also be used over a longer period of time Paracetamol and phenacetin are over-the-counter pain relievers. Since April 2009, paracetamol may only be sold without a prescription up to an active ingredient quantity of 10 grams, which corresponds to a pack of 20 tablets of 500 milligrams each.

Pyrazole derivatives (metamizole, propyphenazone & phenylbutazone)

Metamizole has a strong antipyretic effect and also has a strong pain reliever effect. It also has anti-inflammatory and muscle-relaxing effects (spasmolytic). It is therefore particularly suitable for the therapy of severe acute pain (e.g. after operations, gout) or in tumor therapy for the treatment of pain attacks. A very rare but serious side effect is so-called agranulocytosis, in which the number of white blood cells drops dramatically. In addition, allergic skin reactions must be expected. The other substances in this group of painkillers also have a strong antipyretic, analgesic and anti-inflammatory effect. They must be prescribed by a doctor because of possible side effects.

Nonsteroidal anti-inflammatory drugs (e.g. diclofenac, indomethacin, ibuprofen, naproxen, piroxicam)

They have analgesic, anti-inflammatory and antipyretic properties. They are used to treat inflammatory and rheumatic diseases of the joints. Important side effects of nonsteroidal anti-inflammatory drugs include damage to the gastrointestinal mucosa, which can lead to gastric ulcers and, in rarer cases, gastric bleeding. They can also trigger cardiovascular diseases or asthma and disrupt the fluid and salt balance.

Cyclo-oxygenase-2 inhibitors (COX-2 inhibitors, e.g. celecoxib, etoricoxib)

COX-2 inhibitors suppress the formation of cyclo-oxygenase-2 - an enzyme that promotes the formation of prostaglandins in the event of inflammation or injury. This prevents both inflammatory reactions and the development of pain signals. COX2 inhibitors differ from traditional nonsteroidal anti-inflammatory drugs such as ibuprofen or diclofenac in that they are better tolerated by the stomach. However, they can increase the risk of cardiovascular diseases and should therefore not be taken by heart patients.

Other preparations used in pain therapy

Psychotropic drugs can increase the effects of pain relievers. They change the experience of pain so that the patient suffers less from his pain. Antidepressants have a depressive effect, improve mood but also relieve pain. Pain patients are primarily treated with tricyclic antidepressants, e.g. B. amitriptyline, imipramine or doxepin. Lower doses (e.g. 25 milligrams of amitriptyline per day) are sufficient for pain therapy than for the treatment of depression. Other antidepressants that have a positive effect on pain are mirtazapine and duloxetine.

Neuroleptics have an antipsychotic effect without reducing consciousness and intellectual abilities. They are intended on the one hand to increase the effect of opioids, on the other hand they suppress their undesirable effects, such as. B. Nausea. Haloperidol, for example, works very well against nausea, but is hardly calming, whereas levomepromazine has a strong calming effect and is therefore also suitable as a sleep aid. Possible side effects include movement disorders, dry mouth, constipation, and irregular heartbeat. Tranquillizers reduce anxiety and sleep disorders.

Anticonvulsant drugs - the so-called antiepileptic anticonvulsants - are particularly effective in the case of neuropathic pain of a shooting nature (e.g. trigeminal neuralgia, shingles), example: carbamazepine. They inhibit nerve cells that continuously send out signals and can thus interrupt the transmission of pain signals. Gabapentin or pregabalin can also be used in pain patients.

Corticosteroids work against inflammation and reduce swelling. This will reduce the pressure on the surrounding tissue and thus reduce the pain. You will e.g. It is used, for example, for inflammation and tumors or when nerves in the spinal cord are pinched or squeezed (e.g. in the case of a herniated disc). If possible, they should not be combined with non-steroidal anti-inflammatory drugs, as these increase the risk of gastric ulcer.

Bisphosphonates inhibit bone-degrading cells (osteoclasts) and thus strengthen the bones. Independently of this, however, they also reduce bone pain and are therefore used for osteoporosis, bone cancer or Sudeck's disease.

Flupirtine differs from the other analgesics in structure and effect. The analgesic effectiveness is comparable to that of weakly effective opioids. It also relaxes the muscles. That is why it is also used for tension pain. Possible side effects include tiredness, a dry mouth, and difficulty concentrating.