Date of Award

5-2022

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Jay Metzger

Keywords

Chronic pain; Mood disorders; Serserotonin-norepinephrine reuptake inhibitors (SNRIs)

Abstract

Chronic pain and mood disorders represent two of the most common disorders managed by primary care providers. Chronic pain management is costly, not only with direct medical costs but through loss of work and productivity. The incidence of mood disorders continues to increase, and disorders such as anxiety and depression coexist with chronic pain in many patients. Meanwhile, polypharmacy presents an increased risk for drug-drug interactions and patient harm. The purpose of this systematic literature review is to explore the potential of reducing polypharmacy in individuals with depression and chronic pain through monotherapy via serotonin-norepinephrine reuptake inhibitors (SNRIs). A literature review was performed using search databases PubMed, DynaMed, and Clinical Key, and Google. The review of the literature revealed that treatment of chronic conditions with multiple medications could result in drug-drug interactions and overdose risks. It was also found that SNRIs have a good safety profile and minimal drug-drug interactions. SNRIs target specific pain pathways to include neuropathic, osteoarthritic, and fibromyalgia pain. These pathways are a different target than nociceptive pain, and therefore SNRIs have the ability to specifically target and treat chronic pain. It was also noted that coexisting chronic pain and mood disorders both occur as either a result of each other or found to coexist incidentally through patient surveys and functional MRI imaging. SNRIs have already been proven effective in the management of depression, and the results of this literature review provide evidence that supports SNRI therapy for the treatment of chronic pain. Therefore, management of chronic pain with comorbid depression via SNRI monotherapy is a valid first approach in an effort to reduce polypharmacy.

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