The Utilization of Atypical Antipsychotics in the Pain Medicine Physician’s Armamentarium

I read with great interest the recent article by Jimenez et al, A Systematic Review of Atypical Antipsychotics in Chronic Pain Management: Olanzapine Demonstrates Potential in Central Sensitization, Fibromyalgia, and Headache/Migraine.1 The article states “many psychopharmacologic agents are used as primary or adjuncts in pain management. Atypical antipsychotics (AA) have also been used as adjuncts in pain management regimens in a variety of manners; however, their efficacy in this capacity is unclear. Few studies have been conducted to evaluate the analgesic effects of AAs. The collective findings of multiple studies evaluating olanzapine in pain syndromes suggest a high, yet preliminary level of evidence of efficacy, warranting prospective studies in various pain syndrome contexts.” As a pain medicine physician, I too am cognizant that the shift in the medical world away from non-cancer pharmacologic treatment with opioids further emphasizes the need for alternative types of medicines to treat our chronic pain patients. Although I have been trained to be familiar in treating fibromyalgia, central sensitization, and migraines with psychopharmacologic agents including tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors such as duloxetine, and neuropathic medications including gabapentin, pregabalin, carbamazepine and topiramate, I am far less familiar and comfortable with atypical antipsychotics. Although we as providers know the definitive role of atypical antipsychotics in treating psychosis and mood disorders, we tend to rely on our psychiatrist colleagues to prescribe and treat with this category of medications.