International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 8, Issue 2, pp: (248-260), Month: October 2020 - March 2021, Available at: www.researchpublish.com
A potential impact of Fluoxetine in Neurological Pain: A review Manish Kumar1, Indu Melkani1, Bimlesh Kumar1*, Linu Dash1, Anupriya1, Varimadugu Bhanukirankumar Reddy1, Yousif Al-Daghestani 1
School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
Abstract: Fluoxetine is the first major drug for treating up the neurological pain associated with depression since the evolution of tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) nearly 3 decades earlier. It was the one and only of its kind because of its activity along the selective serotonin reuptake inhibitor (SSRI) which was sanctioned by the United States Food and Drug Administration, offering a good efficacy and a decreased side effects comparatively to TCAs and MAOIs. However, a debate remains active regarding the true mechanism of the drug by which the medical efficacy of fluoxetine is observed, the value of fluoxetine and its related SSRIs to the profession is unquestionable. Prozac has permeated popular culture, helping to raise awareness of depression and to diminish the prevalence of long-standing stigmas associated with this illness. In this Review, we will showcase the history and importance of fluoxetine to neuroscience in general, as well as for the treatment of depression, and review the nature, pharmacology, preclinical reports, and adverse effects of fluoxetine. Keywords: central nervous system, peripheral nervous system, tricyclic anti-depressants, serotonin-norepinephrine reuptake inhibitors.
I. INTRODUCTION According to recent researches in pain management, the brain plays a key role in chronic pain management. So, any injury in the brain can cause chronic neurological pain disease [1, 2]. Neurological pain is an ailment of the central nervous system (CNS) which occurs due to primary lesions or any disturbance in the peripheral nervous system (PNS) or central nervous system and it is also because of rupture of somatosensory nervous system [3-6]. Diabetic neuropathy, post-operative neurological pain, post-treated shingles pain are examples of peripheral neurological pain, and spinal cord affliction, multiple sclerosis, or post-treated stroke pain are examples of central neurological pain [7-9]. Anti-convulsants, tricyclic anti-depressants (TCAs), and selective inhibition of serotonin-norepinephrine reuptake are the first-line treatment for neurological pain. Anticonvulsants like, gabapentin or pregabalin are the GABAergic drugs which act by blockage of calcium-channel as well as TCAs act on sodium channel and shows significant effect [10, 11]. Lidocaine, capsaicin in high dose patches, or tramadol are the second-line treatment and strong opioids are the third-line treatment for neurological pain [12]. But these medications also causes some of the side effects to the body, like the use of TCAs may also cause cardiac blockage, anticholinergic effects (dryness in the oral cavity, constipation, blurred vision), gain in weight, sedation, etc and use of serotonin-norepinephrine reuptake inhibitors (SNRIs) can cause anxiety, hypertension, loss of appetite, mouth dryness, insomnia, etc and use of anticonvulsants can cause edema, dizziness, blurred vision, weight gain, etc [13]. But fluoxetine was the first SNRIs drug, which is having high efficacy and fewer side effects than other TCAs and anti-convulsant drugs. Fluoxetine act by blocking the reuptake of serotonin by transporter protein of reuptake situated on the presynaptic terminal of the presynaptic neuron of serotonin. Fluoxetine also shows activity on 5HT receptors [14]. Preclinical evidences of fluoxetine to establish its efficacy is explained in the present review. A. Definition of neurological Pain According to the International Association for the Study of Pain, Neurological pain is pain “initiated or caused by a primary lesion or dysfunction in the nervous system”. It may occur due to injury in nerve-fiber or damage in a single
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