Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain: Early Evidence and Recommended Future Directions

@article{Wong2014AntidepressantDF,
  title={Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain: Early Evidence and Recommended Future Directions},
  author={Karen Wong and Rachel Phelan and Eija A Kalso and Imelda M Galvin and David H Goldstein and Srinivasa N. Raja and Ian Gilron},
  journal={Anesthesiology},
  year={2014},
  volume={121},
  pages={591–608}
}
Background:This review evaluates trials of antidepressants for acute and chronic postsurgical pain. Methods:Trials were systematically identified using predefined inclusion and exclusion criteria. Extracted data included the following: pain at rest and with movement, adverse effects, and other outcomes. Results:Fifteen studies (985 participants) of early postoperative pain evaluated amitriptyline (three trials), bicifadine (two trials), desipramine (three trials), duloxetine (one trial… 
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98 Citations
Background Citations
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Methods Citations
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Results Citations
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98 Citations

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Citation Type

Antidepressant Drugs for Postsurgical Pain: Current Status and Future Directions
TLDR
Current evidence does not yet support routine use of any one specific antidepressant for treatment of acute, or prevention of chronic, postsurgical pain, but limitations in available trials are such that one cannot yet rule out the possibility that one or more antidepressant drugs may provide benefit in specific populations.
Perioperative duloxetine for acute postoperative analgesia: a meta-analysis of randomized trials
TLDR
Duloxetine, a non-opioid neuromodulator, may provide efficacy for the treatment of acute perioperative pain.
Efficacy of pregabalin in post-traumatic peripheral neuropathic pain: a randomized, double-blind, placebo-controlled phase 3 trial
TLDR
The findings demonstrate the feasibility of conducting a large, phase 3 registration trial in the heterogeneous PTNP study population and show the efficacy and tolerability of pregabalin over 3 months in patients with PTNP.
Duloxetine and Subacute Pain after Knee Arthroplasty when Added to a Multimodal Analgesic Regimen: A Randomized, Placebo-controlled, Triple-blinded Trial
TLDR
Duloxetine does not reduce subacute pain with ambulation when included as a part of a multimodal analgesic regimen for knee arthroplasty, and there was no difference in other side effects or in anxiety and depression scores.
Prevention and Treatment of Chronic Postsurgical Pain: A Narrative Review
TLDR
Several ways by which the limitations of the current approaches could be overcome and enhance the outcome of surgical patients are developed, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management.
Duloxetine as an Analgesic Reduces Opioid Consumption After Spine Surgery: A Randomized, Double-Blind, Controlled Study
TLDR
Duloxetine was effective as an adjunct for postoperative analgesia and reduced opioid consumption during the postoperative period in patients undergoing elective spine surgery.
Auxiliary Therapeutics in the treatment of Acute Pain: New indications for old Drugs
TLDR
The effect of gabapentinoids and ketamine seems to be greater on the reduction of opioid consumption than on postoperative pain as there was a more homogeneous reduction in opioid requirements.
Efficacy of duloxetine compared with opioid for postoperative pain control following total knee arthroplasty
TLDR
Duloxetine and opioid did not show any difference in pain control, function, and side effects for up to one year after TKA and can be considered as an alternative to opioid for postoperative pain control following TKA.
Analgesic Effect of Perioperative Escitalopram in High Pain Catastrophizing Patients after Total Knee Arthroplasty: A Randomized, Double-blind, Placebo-controlled Trial
TLDR
Escitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients, and future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.
Perioperative Multimodal Pain Management: an Evidence-Based Update
TLDR
More high-quality clinical trials and systematic reviews are needed in several drug classes to assess the potential for benefit and risk of harm with respect to perioperative multimodal analgesia.
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