Efficacy of milnacipran in the treatment of chronic pain syndromes

Eleven outpatients with chronic pain syndromes other than fibromyalgia were treated for 12 weeks with milnacipran, a novel serotonin noradrenaline reuptake inhibitor. The agent was administered at 50-150 mg/day, and the mean + SD dose at 12 weeks or at the time drug treatment was stopped was 84.1 +/- 32.2 mg/day. None of the patients met the DSM-IV criteria for a major depressive disorder. Abdominal, chest, back, arm, leg or glossal pain, or headache was involved. Pain was assessed clinically by means of a visual analog scale ( VAS) before and 12 weeks after the start of milnacipran treatment, or at the time drug treatment was stopped. The mean +/- SD decrease in VAS scores was 42.3 +/- 31.6 (50.8 +/- 49.2%). One patient discontinued treatment after 4 weeks because of nausea, whereas others tolerated the agent well. These results suggest that the use of milnacipran in patients with a variety of chronic pain syndromes is beneficial.