Pain Meets Peace: Study Evaluates Dexmedetomidine in Chronic Pain with Anxiety and Depression

Chronic pain frequently coexists with anxiety and depression, complicating treatment outcomes and exacerbating patients' suffering. Dexmedetomidine (DEX), a selective α2-adrenoreceptor agonist used primarily in perioperative settings, has shown promise in alleviating these co-occurring symptoms due to its analgesic and anxiolytic properties. However, its application in chronic pain patients who also suffer from anxiety and depression remains under-researched. To investigate this, a recent retrospective cohort study evaluated patients who received intravenous DEX during interventional pain management procedures.

The study enrolled 306 chronic pain patients who exhibited no less than mild symptoms of anxiety and depression, as assessed by the GAD-7 and PHQ-9 questionnaires. Participants were divided into two groups: those receiving DEX (n=106) and those undergoing local analgesia (LA) (n=184). Propensity score matching ensured balanced characteristics between the DEX and LA groups, facilitating a robust comparison of outcomes.

Results

The findings demonstrated that at one-month follow-up, DEX administration was associated with significantly greater reductions in anxiety (GAD-7 score reduced by -4.43 for DEX vs. -2.42 for LA) and depressive symptoms (PHQ-9 score reduced by -6.19 for DEX vs. -3.92 for LA). Pain relief was also greater in the DEX cohort (-3.32 vs. -2.62 based on the NRS), indicating DEX's effectiveness in managing both physical and psychological distress. Patient satisfaction scores were notably higher in the DEX group, reflecting improvements in anxiety management and overall procedural experiences. Sensitivity analyses reinforced these findings, particularly among patients exhibiting both anxiety and depression, and indicated that approximately 18-32% of anxiety and depression improvements could be directly attributed to pain alleviation. Despite these promising results, limitations included the retrospective design, single-center scope, and short follow-up duration, which may affect generalizability and long-term efficacy assessment. The research suggests DEX may serve as a dual-purpose treatment for chronic pain patients with anxiety and depressive symptoms, acting independently on mood regulation beyond analgesic effects. However, further randomized controlled trials are necessary to confirm DEX's effectiveness, explore neurobiological mechanisms, and determine optimal dosing strategies to enhance outcomes in varied patient populations. Such efforts could lead to integrated approaches in managing chronic pain alongside psychological comorbidities, optimizing therapeutic strategies for multifaceted patient needs.

Key Points

- A retrospective cohort study evaluated the effects of intravenous dexmedetomidine (DEX) in 306 chronic pain patients with mild to moderate symptoms of anxiety and depression, assessing its potential benefits beyond standard local analgesia (LA).

- Participants were divided into two groups: those receiving DEX (n=106) and those receiving LA (n=184), with propensity score matching applied to ensure comparability in demographics and clinical characteristics between the groups.

- Results at one-month follow-up indicated that DEX treatment produced significantly greater reductions in anxiety (GAD-7 score: -4.43 for DEX vs. -2.42 for LA) and depressive symptoms (PHQ-9 score: -6.19 for DEX vs. -3.92 for LA), highlighting DEX's multifaceted role in managing pain and psychological distress.

- The DEX cohort reported greater pain relief measured by the Numeric Rating Scale (NRS) (-3.32 for DEX vs. -2.62 for LA), along with higher patient satisfaction scores, which emphasized the therapeutic value of DEX in enhancing patient experiences during procedural interventions.

- Sensitivity analyses confirmed the robustness of these findings, especially among patients with concomitant anxiety and depression, revealing that 18-32% of the improvements in anxiety and depression could be attributed to pain relief obtained from DEX treatment.

- Limitations of the study include its retrospective design, the single-center nature of the research, and the relatively short follow-up period, which may restrict the generalizability of the results and necessitate further randomized controlled trials to validate DEX's efficacy and explore underlying mechanisms in diverse patient populations.

Reference –

Yiting Ren et al. (2025). Dexmedetomidine For Chronic Pain Patients With Anxiety And Depression: A Propensity Score Matching Cohort Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03087-x.