Paxil (or other antidepressants) for pain management?

In this current thread in MPSIMS they are talking about Paxil. Several posters mention that they are using it for pain management.

This is something I haven’t heard of before. What is the Straight Dope on using Paxil (or other SSRI’s or SNRI’s? or other antidepressants?) for pain management?

(I think I’m asking for plain factual answers, or some semblance thereof, here. Not asking for personal advice for myself (not now anyway). So I think GQ is the place for this.)

I’m at work at the moment, so cites will have to follow at a later time, but in general, SSRI’s do not appear to do any better than placebo as far as pain relief goes. Hypothetically speaking, since we know Major Depressive Disorder and other depressive disorders complicate treatment of pain (and vice-versa) when those conditions are comorbid, successful treatment of the depression with an SSRI should alleviate at least some of the perception of pain, but it would be more of an indirect effect than a direct one.

The antidepressant classes that have the best evidence of efficacy are Tricyclic antidepressants and SNRI’s, though of the latter, the evidence is probably the strongest for Duloxetine (Cymbalta). Off the top of my head the evidence with regards to antidepressants is better for pain of neuropathic origin, but since it has been suggested that part of the process underlying the chronification of pain is an increase in sensitivity to pain at peripheral and/or central levels, they have the potential to be at least somewhat beneficial in most chronified pain states.

Anti-depressants have been used to relieve pain for decades.

FWIW, I do not condone pain avoidance altogether; no pain no gain, etc.

What kind of pain?

I wouldn’t take SSRI’s if my life depended on it.

Thanks for the answers, everybody.

Thanks especially to JayRx1981 for the detailed pharmaceutical answers here and in several other threads too.