Effectiveness of milnacipran for a patient with pain disorder and long QT syndrome.

The effectiveness of tricyclic antidepressants (TCAs) has been reported for treating pain disorder. However, the use of TCAs is contraindicated for patients with congenital long QT syndrome. We experienced a case of a 38-year-old woman with congenital long QT syndrome and pain disorder in the orofacial region, which was treated successfully with milnacipran. Although nortriptyline was effective for her pain, it could bring about fatal cardiac adverse events. Paroxetine was not effective in this case. Six weeks after the increase to 200 mg/d of milnacipran, her pain had completely disappeared, and her corrected QT interval time was 0.445 milliseconds. Milnacipran may be a safe and effective compound for patients with pain disorder in whom TCAs are contraindicated.