Does Pristiq treat nerve pain? (+5 options)

In this article, we will discuss the therapeutic efficacy of Pristiq in treating nerve pain. We will look at some research studies related to the efficacy of Pristiq in treating nerve pain. We will also shed some light on the ways to manage nerve pain if Pristiq does not help.

Does Pristiq treat nerve pain?

Pristiq may help treat nerve pain. Pristiq is an FDA-approved medication for the treatment of major depressive disorder. It may sometimes be used off-label for treating nerve pain comorbid with depression. 

Pristiq is a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant. Pristiq works by blocking the reuptake of serotonin and norepinephrine in the synaptic cleft. This action increases the levels of these neurotransmitters in the brain that help maintain mental balance (1). 

Nerve or neuropathic pain is a broad term relating to chronic pain that is due to damage to the nervous system. Nerve pain could be due to various diagnoses, injuries, or etiologies leading to sharp, tingling, burning, or electric shocklike sensations (2).

Nerve pain can be treated with appropriate pharmacological interventions, physical therapies, and other approaches under the supervision and guidance of a medical practitioner. 

What does research suggest? 

Based on research studies, the use of Pristiq (desvenlafaxine) for neuropathic pain is very limited. Due to the pharmacokinetic properties of this medication, it may be considered useful in some patients with chronic nerve pain comorbid with depression (3). 

Pristiq does not affect P-glycoprotein nor is a sustrate of it. Pristiq also has no direct effect on the cytochrome P-450 system therefore, it has no interactions with other medications working via this mechanism. This action of Pristiq makes it stand out among other antidepressants in treating neuropathic pain (3).

Research studies have revealed that SNRI antidepressant medications including desvenlafaxine, duloxetine, and venlafaxine are increasingly used for chronic neuropathic pains (4). 

What is the link between antidepressants and nerve pain? 

There is no known connection or link between nerve pain and antidepressants. However, antidepressants have been effective and promising in treating chronic nerve pains based on various mechanisms (2). 

The most accepted connection that is related to the therapeutic efficacy of SNRI antidepressants on nerve pain is the impact of these drugs on the serotonin and norepinephrine neurotransmitters along the descending spinal pain pathways (2).

Various antidepressants belonging to different classes may exert their action on histamine receptors as well as through sodium channel modulation which is also beneficial in reducing nerve pain (2).  

How is nerve pain connected to depression?

Nerve pain is usually comorbid with depression. Studies have shown that about 57% of depressive patients have an increased risk of nerve pain as compared to the normal population (2). 

However, nerve pain comorbid with depression shares common symptoms such as fatigue, tiredness, and sleep disturbances which makes it difficult to assess and differentiate depression from nerve pain (2). 

However, the most common hypothesis regarding this comorbidity is that depression precedes nerve pain and vice versa. Previous depression might exacerbate the potential of subsequent depression and induce a new onset of nerve pain in some patients (2). 

Therefore, considering antidepressant therapy for nerve pain is most common in patients who are already suffering from depression along with nerve pain. The dosing of antidepressants for nerve pain is much lower as compared to treating depression (2). 

What are the approved medications for nerve pain?

The following medications are approved for treating nerve pain in patients (3,5):

Antiepileptics- (first-line treatment) 

Other SNRIs- (first-line treatment)

Tricyclic antidepressants- (first-line treatment)

  • Amitriptaline (Elavil)
  • Nortriptyline (Aventyl)  

Topicals- (second-line treatment)

  • Lidocaine (5% patches)
  • Capsaicin cream (8% patches)

What to do if Pristiq does not help with nerve pain?

If you suspect that Pristiq is not helping with nerve pain, then you should consult your healthcare provider. 

If Pristiq is causing more harm than benefits with regards to treating nerve pain, then your doctor might consider switching you to other medications that can outweigh the benefits over risks and help in alleviating symptoms of nerve pain. 

Your doctor may also suggest some complementary treatments for nerve pain such as acupuncture, electrostimulation, herbal medicine, or supplementation which have proven beneficial in treating nerve pain in patients.  

However, I would recommend that if you feel that Pristiq is not working or is causing severe side effects, then do not stop taking the medication immediately without informing your doctor as it may cause severe consequences. 

Always keep your doctor in the loop and have transparent and honest discussions with your doctor about your symptoms and side effects to receive better and more efficient treatment. 

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