Tricyclic Anti-Depressants for Back Pain Relief

Pain killers have side effects you should know about before you take them. Jamie Grill/Tetra images/Getty Images

If you don't know by now, pain and depression are closely related. According to an article published in U.S. Pharmacist in 2009, the symptoms of these two conditions overlap.  The article reports on data from the National Health and Nutrition Examination Survey III  finding that up to 10% of the population experiences depression, of which 90% report having pain.

The article goes on to say that the biological basis for depression is also a potential player in what underlies chronic pain. For this reason, antidepressants may make an effective type of medication for chronic neck or back pain.

In fact, antidepressants have been proven effective for various types of chronic pain, including nerve pain, physical pain associated with depression, and fibromyalgia, according to the article.  The authors say that different classes of antidepressant are effective for different types of pain. 

Types of tricyclic antidepressants prescribed for nerve pain include amitriptyline, nortriptyline, desipramine, as well as novel antidepressants bupropion, venlafaxine, and duloxetine (brand name Cymbalta.)  

About Tricyclic Antidepressants

Tricyclic antidepressants are a class of medications approved by the FDA for treating depression. Although the FDA doesn't approve them as pain treatment, doctors sometimes prescribe them for this use anyway.(This is called off-label prescribing.)  When antidepressants are taken for  nerve pain, it's as an adjuvant, i.e., a helpful add-on to the main medication protocol 

If you are taking a tricyclic antidepressant for pain, your dose will likely be lower than if you are taking it for depression.

Side Effects

The targets of tricyclic antidepressants are not limited to depression and pain. These drugs affect a number of body systems. Because of this, a range of side effects can occur. The side effects may be manageable (dry mouth, constipation, drowsiness) or very serious (rapid heartbeat, aggravation of glaucoma, increased risk of seizures, to name a few.) It is important that you have an honest discussion with your doctor about any other conditions you may have so that she can accurately determine if this type of pain medication is a good fit for you.

As mentioned above, some of the novel antidepressants are effective for managing neuropathic back pain. The good news is that they may also incur fewer side effects than other types of tricyclic antidepressants. On the downside, some novel antidepressants are so highly targeted to chemical interactions that relate to depression, that unless the pain is attributable to an underlying psychological problem, these drugs may not be effective in relieving it.

Also called anti-seizure medications, other types of adjuvant pain medications used to treat chronic back pain are those in the anticonvulsant class. Anti-seizure medications for chronic back pain work about as well as antidepressants but come with different safety and side effect warnings. This type of drug may make a better choice for seniors and the elderly because the safety concerns are fewer than for antidepressants.

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Article Sources
  • Maizels, Morris, MD, & McCarberg, Bill, MD (2005). Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain. American Family Physician, 71.
  • Gould, Harry J., III, MD. Understanding Pain: What it is Why it Happens, and How it's Managed. New York: Demos, 2007. Print
  • Fink, K., MD, Director Pain Services. National Rehabilitation Hospital, Washington, DC. Telephone Interview. March 9, 2009.
  • Moultry, A., PharmD, MS; Poon, I. PharmD, BCPS, CGP. The Use of Antidepressants for Chronic Pain. US Pharmacist. 2009.Medscape website.