this post was submitted on 11 Jul 2024
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My wife has had a chronic neuropathic pain condition since 2008, and this is pretty accurate. One of the interesting aspects of chronic pain is that there's no way to measure it - no way for a doctor to know how much pain a person is in other than to ask, and the answer is inherently subjective. I've seen with my wife that clearly the pain itself can vary, with one day being better or worse than the prior, but also her ability to deal with it varies. If she's tired, emotional, or cranky, the same amount of pain can be untenable.
They sometimes use antidepressants for neuropathic pain, and as I understand it the thinking is that they influence how pain is proceeded in the brain, but I always wonder if part of the success is simply that people on antidepressants get less derailed by a given level of pain.
Some of the anti-depressant meds affect things like GABA or norepinephrine (so an SNRI as opposed to SSRI), so it's not just the anti-depressant angle, as they're often used in much smaller doses than when used for depression.
It's pretty fascinating stuff - I just learned about the norepinephrine angle recently. The thinking is that chronic pain causes people to become more sensitive to small pain signals - their nervous system is over-sensitized to pain, and these meds help with reducing the signaling/response to signals.
If you're curious, lookup gabapentin (it's been around for at least 30 years) or tramadol (an SNRI), which has also been around a long time.
My wife has been on both of those. Neither at the moment.