Benzodiazepines and Anxiolytics

Benzodiazepines have been employed acutely to mitigate pain arising from muscle spasm (e.g., after spinal cord injury). The presumption is that patients with marked anxiety are prone to heightened muscle tension, which may exacerbate musculoskeletal pain. Other uses for benzodiazepines have included treatment of restless legs syndrome, tension headache, and neuropathy (Bartusch et al. 1996 Bouckoms and Litman 1985 Dellemijn and Fields 1994). Clonazepam, a long-acting benzodiazepine, might be...

Muscle Antispasmodics

Muscle antispasmodics include true muscle relaxants (e.g., baclofen, dantro-lene) along with agents in which the mechanism of action is unclear (e.g., car-isoprodol, cyclobenzaprine, methocarbamol, orphenadrine). Some of these agents may suppress polysynaptic reflexes and thereby reduce pain, but they do not influence skeletal muscles per se. Generally, antispasmodic agents are to be used for acute pain arising from muscle strain or injury (see Table 5-14). Baclofen might be indicated for more...

Somatic Amplification and Its Function

In some patients with pain, like patients with other somatoform disorders, amplification of somatic symptoms (including pain) may be a manifestation of psychological distress. For some persons, this amplification might reflect a strategy to cope with or manage psychological distress (Lipowski 1988). For others, somatic amplification may result from the distress associated with unpleasant affective states such as depression or anxiety. These emotional states may lead to heightened...

Serotonin Norepinephrine Reuptake Inhibitors

The serotonin-norepinephrine reuptake inhibitors SNRIs i.e., venlafaxine and duloxetine have demonstrated utility as analgesic agents, and they bypass several of the untoward effects commonly associated with the TCAs. Both agents have been demonstrated to have pain-mitigating effects in randomized con- Table 5-5. Analgesic effects of antidepressants Table 5-5. Analgesic effects of antidepressants preventing further pain augmentation Decreased firing of neurons, reduced Note. 5-HT serotonin GABA...