Milnacipran is a novel
serotonin noradrenaline reuptake inhibitor. The authors describe the use of
milnacipran for the treatment of
chronic pain in a series of patients. There were 5 outpatients who suffered
chronic pain for at least 3 months. None of these patients met the DSM-IV criteria for a
major depressive disorder.
Chronic pain was assessed clinically by means of a visual analog scale (VAS) before and 12 weeks after the start of the
milnacipran treatment or at the time the
drug was stopped. The duration of
pain was 17.8 +/- 9.3 months (mean +/- SD), and the baseline VAS score was 88.2 +/- 6.3 points.
Milnacipran was administered at 50 to 150 mg/day, and the dose at 12 weeks or at the time the
drug was stopped was 85.0 +/- 31.3 mg/day. The mean +/- SD decrease in VAS at this time was 61.2 +/- 15.5%. Three patients showed marked improvement (decrease in VAS, >75%). Their decreases in VAS scores were 86.5%, 85.7%, and 77.6%. One patient showed mild improvement (42.0% decrease in VAS). These 4 patients tolerated the
drug well. The fifth patient experienced
nausea and discontinued treatment after 4 weeks. The VAS decrease for this patient was 14.3%. Results of this study show
milnacipran to be beneficial in patients with
chronic pain. This
drug should be studied further for its effectiveness in the treatment of
chronic pain.