SSNRI

However, off-label use of unconventional choices--including tricyclic and selective serotonin norepinephrine receptor inhibitor (SSNRI) antidepressants and anticonvulsants--also are sometimes appropriate for use in children, depending on the type, duration, and intensity of pain being treated and the desired, as well as unwanted, side effects.

Duloxetine (Cymbalta) is an SSNRI and may be a more appropriate choice for children who are in pain--and perhaps depressed as well--than the antidepressant venlafaxine (Effexor), nicknamed "Side Effexor" for its unfortunate proclivity to cause anxiety, insomnia, decreased growth, hypercholesterolemia, and sustained hypertension, he said.