Table 9.

Medications for generalized pain.

Medication	Usual adolescent dose	Comments
Tricyclics		See Table 7
Selective serotonin reuptake inhibitors or SNRIs
Sertraline HCl Escitalopram Venlafaxine HCl Duloxetine HCl Bupropion HCl	25–100 mg daily 5–20 mg daily 37.5–225 mg daily 20–60 mg daily 150–300 mg daily	Consider in patients with co-morbid anxiety or depression. These medications should not be stopped suddenly. Patients should be weaned very gradually off them, especially duloxetine. Duloxetine can be helpful for fibromyalgia
Anticonvulsants
Topiramate (Topamax)	25–100 mg bid	Helpful for widespread pain, continuous headaches, and fibromyalgia. Can cause weight loss
Gabapentin	300–1,200 mg tid	Adverse effects of topiramate include suicidal feelings and cognitive problems with doses >50 mg daily
Pregabalin (Lyrica)	25–50 mg at night increasing to 25–100 mg tid	Gabapentin can cause somnolence and weight gain
Valproic acid	250–500 mg bid