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Perspectives

Are antipsychotic medications suitable for chronic noncancer pain?

RICHARD O. DAY, MILTON L. COHEN

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Abstract

The role of pharmacotherapy in the management of patients with chronic noncancer pain is limited and should be part of an interdisciplinary approach tailored to the individual. There is no rationale or evidence for using antipsychotic drugs in this context.

Key Points

  • Chronic noncancer pain is a complex experience that requires assessment in somatic, psychological and social dimensions, ideally to inform an interdisciplinary approach to management.
  • Doctors and patients have relied excessively on medication for treating chronic noncancer pain, despite the moderate track record of commonly used agents – opioids, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors and gabapentinoids.
  • There is no rationale or evidence for using antipsychotic agents to treat the experience of pain; the increased use of these drugs instead reflects a quest to suppress distressing behaviour.
  • The adverse effects of antipsychotic medicines are underappreciated but should temper enthusiasm for their use for any reason other than treating patients with psychotic symptoms.

    Picture credit: © Wong Sze Fei/adobe.stock.com
    Model used for illustrative purposes only.

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