A review of SSRIs and SNRIs in neuropathic pain

Importance of the field: Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are becoming increasingly used in the treatment of neuropathic pain and fibromyalgia. However, they are not without adverse effects and their efficacy has not been clear because of conflicting evidence. Areas covered in this review: We have examined the current evidence on the efficacy of SSRIs and SNRIs in the treatment of neuropathic pain and fibromyalgia. Relevant randomized, placebo-controlled studies were identified through a MEDLINE search of English-language literature from January 1990 to December 2009. What the reader will gain: The evidence for efficacy of SSRIs in the treatment neuropathic pain is moderate at best. However, SNRIs, venlafaxine and duloxetine have been shown to be effective in the treatment of painful diabetic neuropathy and polyneuropathy. With fibromyalgia, both SSRIs (fluoxetine and paroxetine) and SNRIs (duloxetine and milnacipran) have been shown to improve pain relief, function and quality of life. Take home message: SSRIs and SNRIs may be considered in the treatment of neuropathic pain if treatment with tricyclic antidepressants and anticonvulsants fails, or if there are contraindications to these drugs. There is also sufficient evidence to indicate that SNRIs are effective in the treatment of fibromyalgia and may be considered early in the treatment of fibromyalgia.