Korean J Pain.  2019 Jan;32(1):3-11. 10.3344/kjp.2019.32.1.3.

Antipsychotics for patients with pain

• Shin SW
• Lee JS
• Abdi S
• Lee SJ
• Kim KH

• KMID: 2430758
• DOI: http://doi.org/10.3344/kjp.2019.32.1.3

Abstract

Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (α), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak D₂ receptor bindings with strong binding to the 5-HT(2A) receptor, while typical antipsychotics block long-lasting, tight D₂ receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.

Keyword

Antipsychotics; Dopamine; Drug related side effects and adverse reactions; Dâ‚‚ receptor antagonists; Extrapyramidal symptom; Histamine; Pain; Prolactin; Psychosis; Serotonin; Weight gain

MeSH Terms

Affective Symptoms
Analgesics
Antidepressive Agents
Antipsychotic Agents*
Delusions
Dopamine
Drug-Related Side Effects and Adverse Reactions
Dystonia
Hallucinations
Histamine
Humans
Movement Disorders
Norepinephrine
Pain Management
Prolactin
Psychomotor Agitation
Psychotic Disorders
Receptor, Serotonin, 5-HT2A
Receptors, Neurotransmitter
Serotonin
Weight Gain
Analgesics
Antidepressive Agents
Antipsychotic Agents
Dopamine
Histamine
Norepinephrine
Prolactin
Receptor, Serotonin, 5-HT2A
Receptors, Neurotransmitter
Serotonin

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