Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T16:59:55.113Z Has data issue: false hasContentIssue false
  • English
  • Français

Change in Pain Severity With Open Label Venlafaxine Use in Patients With a Depressive Symptomatology: An Observational Study in Primary Care

Published online by Cambridge University Press:  06 March 2008

Stefan Begré ,
Martin Traber ,
Martin Gerber  and
Roland von Känel
Stefan Begré*
Affiliation:
Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital/Inselspital, CH-3010Bern, Switzerland
Martin Traber
Affiliation:
Wyeth Pharmaceuticals AG, Grafenauweg 10, CH-6301Zug, Switzerland
Martin Gerber
Affiliation:
GEM Clinical Research Consulting M. Gerber, Gewerbestrasse 6, CH-6314Unterägeri/ZG, Switzerland
Roland von Känel
Affiliation:
Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital/Inselspital, CH-3010Bern, Switzerland
*
∗Corresponding author. Tel.: +41 31 632 20 19; fax: +41 31 382 11 84. E-mail addresses: [email protected] (S. Begré), [email protected] (M. Traber), [email protected] (M. Gerber), [email protected] (R. von Känel).
Get access

Abstract

Purpose.

Venlafaxine has shown benefit in the treatment of depression and pain. Worldwide data are extensively lacking investigating the outcome of chronic pain patients with depressive symptoms treated by venlafaxine in the primary care setting. This observational study aimed to elucidate the efficacy of venlafaxine and its prescription by Swiss primary care physicians and psychiatrists in patients with chronic pain and depressive symptomatology.

Subjects and methods.

We studied 505 patients with depressive symptoms suffering from chronic pain in a prospective naturalistic Swiss community based observational trial with venlafaxine in primary care. These patients have been treated with venlafaxine by 122 physicians, namely psychiatrists, general practitioners, and internists.

Results.

On average, patients were treated with 143 ± 75 mg (0–450 mg) venlafaxine daily for a follow-up of three months. Venlafaxine proved to be beneficial in the treatment of both depressive symptoms and chronic pain.

Discussion.

Although side effects were absent in most patients, physicians might have frequently omitted satisfactory response rate of depression by underdosing venlafaxine. Our results reflect the complexity in the treatment of chronic pain in patients with depressive symptoms in primary care.

Conclusion.

Further randomized dose-finding studies are needed to learn more about the appropriate dosage in treating depression and comorbid pain with venlafaxine.

Keywords

PainUnipolar depressionAntidepressantPsychiatry in EuropeSwitzerlandPrimary careVenlafaxineClinical care
Type
Original article
Information
European Psychiatry , Volume 23 , Issue 3 , April 2008 , pp. 178 - 186
Copyright
Copyright © European Psychiatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Tel.: +41 41 729 03 21; fax: +41 41 729 03 03.

2

Tel.: +41 31 632 20 19; fax: +41 31 382 11 84.

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed.; 1994.Google Scholar
Ansari, A.The efficacy of newer antidepressants in the treatment of chronic pain: a review of current literature. Harv Rev Psychiatry 2000;7(5):257–277.CrossRefGoogle ScholarPubMed
Arnow, B.A., Hunkeler, E.M., Blasey, C.M., Lee, J., Constantino, M.J., Fireman, B.et al.Comorbid depression, chronic pain, disability in primary care. Psychosom Med 2006;68(2):262–268.CrossRefGoogle ScholarPubMed
Bagby, R.M., Ryder, A.G., Schuller, D.R., Marshall, M.B.The Hamilton depression rating scale: has the gold standard become a lead weight?. Am J Psychiatry 2004;161(12):2163–2177.CrossRefGoogle ScholarPubMed
Bair, M.J., Robinson, R.L., Katon, W., Kroenke, K.Depression and pain comorbidity: a literature review. Arch Intern Med 2003;163(20):2433–2445.CrossRefGoogle ScholarPubMed
Bair, M.J., Robinson, R.L., Eckert, G.J., Stang, P.E., Croghan, T.W., Kroenke, K.Impact of pain on depression treatment response in primary care. Psychosom Med 2004;66(1):17–22.CrossRefGoogle ScholarPubMed
Bandelow, B., Baldwin, D.S., Dolberg, O.T., andersen, H.F., Stein, D.J.What is the threshold for symptomatic response and remission for major depressive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder?. J Clin Psychiatry 2006;67(9):1428–1434.CrossRefGoogle ScholarPubMed
Bradley, R.H., Barkin, R.L., Jerome, J., DeYoung, K., Dodge, C.W.Efficacy of venlafaxine for the long term treatment of chronic pain with associated major depressive disorder. Am J Ther 2003;10(5):318–323.CrossRefGoogle Scholar
Bryson, H.M., Wilde, M.I.Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states. Drugs Aging 1996;8(6):459–476.CrossRefGoogle ScholarPubMed
Debonnel, G., Saint-andre, E., Hebert, C., de Montigny, C., Lavoie, N., Blier, P.Differential physiological effects of a low dose and high doses of venlafaxine in major depression. Int J Neuropsychopharmacol 2007;10(1):51–61.CrossRefGoogle ScholarPubMed
Dick, I.E., Brochu, R.M., Purohit, Y., Kaczorowski, G.J., Martin, W.J., Priest, B.T.Sodium channel blockade may contribute to the analgesic efficacy of antidepressants. J Pain 2007;8(4):315–324.CrossRefGoogle ScholarPubMed
Enggaard, T.P., Klitgaard, N.A., Gram, L.F., Arendt-Nielsen, L., Sindrup, S.H.Specific effect of venlafaxine on single and repetitive experimental painful stimuli in humans. Clin Pharmacol Ther 2001;69(4):245–251.Google ScholarPubMed
Fishbain, D.A., Cutler, R., Rosomoff, H.L., Rosomoff, R.S.Evidence-based data from animal and human experimental studies on pain relief with antidepressants: a structured review. Pain Med 2000;1(4):310–316.CrossRefGoogle ScholarPubMed
Freeman, E.W., Rickels, K., Yonkers, K.A., Kunz, N.R., McPherson, M., Upton, G.V.Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet Gynecol 985 Pt 12001 737–744.Google ScholarPubMed
Gureje, O.Psychiatric aspects of pain. Curr Opin Psychiatry 2007;20(1):42–46.Google ScholarPubMed
Gutierrez, M.A., Stimmel, G.L., Aiso, J.Y.Venlafaxine: a 2003 update. Clin Ther 2003;25(8):2138–2154.CrossRefGoogle ScholarPubMed
Guy, W.ECDEU assessment manual for psychopharmacology. Revised ed.Rockville: National Institute for Mental Health; 1976.Google Scholar
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatr 1960;23:56–62.CrossRefGoogle ScholarPubMed
Harvey, A.T., Rudolph, R.L., Preskorn, S.H.Evidence of the dual mechanisms of action of venlafaxine. Arch Gen Psychiatry 2000;57(5):503–509.Google ScholarPubMed
Janca, A., Hiller, W.ICD-10 checklists – a tool for clinicians' use of the ICD-10 classification of mental and behavioral disorders. Compr Psychiatry 1996;37(3):180–187.CrossRefGoogle ScholarPubMed
Karp, J.F.Venlafaxine XR and chronic pelvic pain syndrome. J Clin Psychiatry 2004;65(6):880–881.CrossRefGoogle ScholarPubMed
Khalifa, M., Daleau, P., Turgeon, J.Mechanism of sodium channel block by venlafaxine in guinea pig ventricular myocytes. J Pharmacol Exp Ther 1999;291(1):280–284.Google ScholarPubMed
Kroenke, K., Messina, N. III, Benattia, I., Graepel, J., Musgnung, J.Venlafaxine extended release in the short-term treatment of depressed and anxious primary care patients with multisomatoform disorder. J Clin Psychiatry 2006;67(1):72–80.CrossRefGoogle ScholarPubMed
Max, M.B.Treatment of post-herpetic neuralgia: antidepressants. Ann Neurol 1994;35(Suppl.):S50–S53.CrossRefGoogle ScholarPubMed
Max, M.B., Lynch, S.A., Muir, J., Shoaf, S.E., Smoller, B., Dubner, R.Effects of desipramine, amitriptyline, fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992;326(19):1250–1256.Google ScholarPubMed
Mbaya, P.Safety and efficacy of high dose of venlafaxine XL in treatment resistant major depression. Hum Psychopharmacol 2002;17(7):335–339.Google ScholarPubMed
Montauk, S.L., Martin, J.Treating chronic pain. Am Fam Physician 1997;55(4):1151–1156.Google ScholarPubMed
Murray, C.J., Lopez, A.D.Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet 1997;349(9064):1498–1504.CrossRefGoogle ScholarPubMed
Nierenberg, A.A., Feighner, J.P., Rudolph, R., Cole, J.O., Sullivan, J.Venlafaxine for treatment-resistant unipolar depression. J Clin Psychopharmacol 1994;14(6):419–423.CrossRefGoogle ScholarPubMed
Ozyalcin, S.N., Talu, G.K., Kiziltan, E., Yucel, B., Ertas, M., Disci, R.The efficacy and safety of venlafaxine in the prophylaxis of migraine. Headache 2005;45(2):144–152.CrossRefGoogle ScholarPubMed
Reuben, S.S.The prevention of post-surgical neuralgia. Pain 2005;113(1–2):242–243.CrossRefGoogle ScholarPubMed
Rowbotham, M.C., Goli, V., Kunz, N.R., Lei, D.Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. Pain 2004;110(3):697–706.CrossRefGoogle ScholarPubMed
Rudolph, R.L., Fabre, L.F., Feighner, J.P., Rickels, K., Entsuah, R., Derivan, A.T.A randomized, placebo-controlled, dose–response trial of venlafaxine hydrochloride in the treatment of major depression. J Clin Psychiatry 1998;59(3):116–122.CrossRefGoogle ScholarPubMed
Saarto, T., Wiffen, P.J.Antidepressants for neuropathic pain. Cochrane Database Syst Rev32005 CD005454CrossRefGoogle ScholarPubMed
Sayar, K., Aksu, G., Ak, I., Tosun, M.Venlafaxine treatment of fibromyalgia. Ann Pharmacother 2003;37(11):1561–1565.CrossRefGoogle ScholarPubMed
Sindrup, S.H., Otto, M., Finnerup, N.B., Jensen, T.S.Antidepressants in the treatment of neuropathic pain. Basic Clin Pharmacol Toxicol 2005;96(6):399–409.CrossRefGoogle ScholarPubMed
Sindrup, S.H., Gram, L.F., Skjold, T., Froland, A., Beck-Nielsen, H.Concentration-response relationship in imipramine treatment of diabetic neuropathy symptoms. Clin Pharmacol Ther 1990;47(4):509–515.CrossRefGoogle ScholarPubMed
Sir, A., D'Souza, R.F., Uguz, S., George, T., Vahip, S., Hopwood, M.et al.Randomized trial of sertraline versus venlafaxine XR in major depression: efficacy and discontinuation symptoms. J Clin Psychiatry 2005;66(10):1312–1320.Google ScholarPubMed
Stahl, S.M., Grady, M.M., Moret, C., Briley, M.SNRIs: their pharmacology, clinical efficacy, tolerability in comparison with other classes of antidepressants. CNS Spectr 2005;10(9):732–747.CrossRefGoogle ScholarPubMed
Staiger, T.O., Gaster, B., Sullivan, M.D., Deyo, R.A.Systematic review of antidepressants in the treatment of chronic low back pain. Spine 2003;28(22):2540–2545.CrossRefGoogle ScholarPubMed
Songer, D.A., Schulte, H.Venlafaxine for the treatment of chronic pain. Am J Psychiatry 1996;153(5):737.Google ScholarPubMed
Thase, M.E.Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3744 depressed patients. J Clin Psychiatry 1998;59(10):502–508.Google ScholarPubMed
Thase, M.E.Treatment of anxiety disorders with venlafaxine XR. Expert Rev Neurother 2006;6(3):269–282.CrossRefGoogle ScholarPubMed
Van Os, T.W., Van den Brink, R.H., Van der, M.K., Ormel, J.The care provided by general practitioners for persistent depression. Eur Psychiatry 2006;21(2):87–92.CrossRefGoogle ScholarPubMed
Wang, G.K., Russell, C., Wang, S.Y.State-dependent block of voltage-gated Na+ channels by amitriptyline via the local anesthetic receptor and its implication for neuropathic pain. Pain 2004;110(1–2):166–174.Google ScholarPubMed
Wellington, K., Perry, C.M.Venlafaxine extended-release: a review of its use in the management of major depression. CNS Drugs 2001;15(8):643–669.CrossRefGoogle ScholarPubMed
Zissis, N.P., Harmoussi, S., Vlaikidis, N., Mitsikostas, D., Thomaidis, T., Georgiadis, G.et al.A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia 2007;27(4):315–324.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.