Antidepressants have been successfully used for chronic pain syndromes for approximately 30 years. One theory is that analgesic action is secondary to the antidepressant effects of the medications. Placebo-controlled trials have documented that antidepressants treat neuropathic pain, musculoskeletal pain, chronic pain, and cancer pain. The most frequently studied antidepressant for pain is amitriptyline. Other antidepressants that have shown analgesic activity include imipramine, citalopram, paroxetine, nortriptyline, desipramine, and mianserin. Fluoxetine and trazodone have not been shown to successfully treat pain syndromes. Venlafaxine, a new antidepressant, most recently was shown to have antidepressant activity in fibromyalgia. More studies need to be done with newer antidepressants to confirm their place in treating pain syndromes.
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References
1.
Paoli F.,Darcourt G.,Cossa P..Note preliminaire sur l'action de l'imipramine dans les etats douloureux.Revue Neurologique. 1960;:503-4
2.
Watson C. P.,Evans R. J.,Reed K..Amitriptyline versus placebo in post-herpetic neuralgia.Neurology. 1982;32:671-3
3.
Ventafridda V.,Bianchi M.,Ripamonti C..Studies on the effect of antidepressant drugs on the antinocioceptive action of morphine and on plasma morphine in rat and man.Pain. 1990;43:155-62
4.
Lynch S.,Max M. B.,Muir J..Effect of antidepressants in relieving diabetic neuropathy pain: amitriptyline versus desipramine and fluoxetine versus placebo.Neurology, suppl. 1990;1:437
5.
Sindrup S. H.,Gram L. F.,Brosen K..The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathic symptoms.Pain. 1990;42:135-44
6.
Sindrup S. H.,Bjerre U.,Dejgaard A..The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy.Clin Pharmacol Ther. 1992;:547-52
7.
Watson C. P.,Evans R. J..A comparative trial of amitriptyline and zimelidine in postherpetic neuralgia.Pain. 1985;23:357-60
8.
Bowsher D..Neurogenic pain syndromes and their management.Br Med Bull. 1991;47:644-66
9.
Max M. B.,Culnane M.,Shafer S. C..Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood.Neurology. 1987;371:589-96
10.
Agnew D. C.,Shetter A. G.,Segall H.D..Thalamic pain.Adv Pain Res Ther. 1983;5:941-6
11.
Leijon G.,Bovie J..Central post-stroke pain—a controlled trial of amitriptyline and carbamazepine.Pain. 1989;36:27-36
12.
Koppel B. S..Amitriptyline in the treatment of thalamic pain.South Med J. 1986;79:759-61
13.
Kluger N. J.,Clifford J. S.,Cavanagh R. J..A case of a chemically dependent patient with a thalamic pain syndrome treated with amitriptyline.J Addict. 1991;10:97-102
14.
Gonzales G. R.,Herskowitz S.,Roseblum M..Central pain from cerebral abbess thalmic syndrome in AIDS patients with toxoplasmosis.Neuro. 1992;42:107-9
Sindrup S. H.,Gram L. F.,Skjold T..Clomipramine versus desipramine versus placebo in the treatment of diabetic neuropathy symptoms. A double-blind crossover study.Br J Clin Pharmacol. 1990;30:683-91
17.
Sindrup S. H.,Ejlertsen B.,Froland A..Imipramine treatment in diabetic neuropathy relief of subjective symptoms without changes in peripheral and autonomic nerve function.Eur J Clin Pharmaco. 1989;37:151-3
18.
Max M. B.,Kumar-Kishore R.,Schafer S.C..Efficacy of desipramine in painful diabetic neuropathy: a placebo controlled trial.Pain. 1991;45:3-9
19.
Kvinesdal B.,Molin J.,Froland A..Imipramine treatment of painful diabetic neuropathy: a placebo controlled trial.JAMA. 1984;251 (17): 27-30
20.
Gomez-Perez E. J.,Rull J. A.,Dies H..Nortriptyline and fluphenazine in the symptomatic treatment of diabetic neuropathy. A double blind crossover study.Pain. 1985;23:395-400
21.
Sindrup S. H.,Tuxe C.,Gram L. F..The effect of mianserin on the symptoms of diabetic neuropathy.Eur J Clin Pharmacol. 1992;43:251-5
22.
Max M. B.,Lynch S. A.,Muir J..Effects of desipramine, amitriptyline and fluoxetine on pain in diabetic neuropathy.NEJM. 1992;326:1250-6
23.
Woodforde J. M.,Dwyer B.,McEwen B. W..Treatment of post-herpetic neuralgia.Med J Aust. 1965;2:869-72
24.
Watson C. P. N.,Watt V. R.,Chapman M..The prognosis with post herpetic neuralgia.Pain. 1991;46:145-9
25.
Max M. B.,Shafer S. C.,Culnane M..Amitriptyline but not lorazepam relieves post-herpetic neuralgia.Neurology. 1988;38:1427-32
26.
Watson C. P.,Evans R. J.,Reed R..Amitriptyline versus placebo in postherpetic neuralgia.Neurology. 1982;32:671-3
27.
Watson C. P.,Evans R. T..A comparative trial of amitriptyline and zimelidine in post herpetic neuralgia.Pain. 1985;23:87-94
28.
Watson C. P.,Chipne M.,Reed K..Amitriptyline versus maprotiline in post herpetic neuralgia: a randomized double blind crossover trial.Pain. 1992;48:29-36
29.
Kishore-Kuna R.,Max M. B.,Schafer S. C..Desipramine relieves post herpetic neuralgia.Clin Pharmacol Ther. 1990;47:305-12
30.
Feinmann C.,Harris M..Psychogenic facial pain, management and prognosis.Br Dent J. 1984;156:205-8
31.
Lascelles R. G..Atypical facial pain and depression.Br J Psychiatry. 1966;112:651-9
32.
Frank R. G.,Kashani J. H.,Parker J. C..Antidepressant analgesia in rheumatoid arthritis.Rheumatol. 1988;15:1632-8
33.
Grace E. M.,Bellamy N.,Kassam Y..Controlled double-blind randomized trial of amitriptyline in relieving articular pain and tenderness in patients with rheumatoid arthritis.Curr Med Res Opin. 1985;9:41-49
34.
McDonald W. A. Scott.The relief of pain with an antidepressant in arthritis.Practitioner. 1969;:202
35.
Gringras M..A clinical trial of tofranil in rheumatic pain in general practice.J Intern Med Res. 1976;4:41-9
36.
Macfarlane J. G.,Jalali S.,Grace E. M..Triimipramine in rheumatoid arthritis: a double blind trial in relieving pain and joint tenderness in patients with rheumatoid arthritis.Curr Med Res Opin.. 1986;10:89-93
37.
Wheatley D..Antidepressants in elderly arthritics.Practitioners. 1986;230:477-8
38.
Clauw F. J..Fibromyalgia: more than just a musculoskeletal disease.Am Fam Physician. 1995;52:843-51
39.
Carette S.,Bell M. J.,Reynolds W. J..Comparison of amitriptyline in primary fibrositis. A double-blind placebo controlled study.Arthritis Rheum.. 1986;29:655-9
40.
40.GoldenbergD. L.FelsonD. T.DinermanH.. 1986. A randomized controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum.29:1371–7.
41.
Jaeschke R.,Adachi J.,Guyatt G..Clin usefullness of amitriptyline in fibromyalgia: the results of 23 n of 1 randomized controlled trials.J. Rheum. 1991;18:447-51
42.
Scudds R. A.,McCain G. A.,Rollman G. B..Improvements in pain responsiveness in patients with fibrositis after successful treatment with amitriptyline.J. Rheumatol. 1989;19:98-103
43.
Carette S.,Bll M. J.,Reynolds W. J..Comparison of amitriptyline, cyclobenzaprine and placebo in the treatment of fibromyalgia: a randomized double-blind trial.Arthritis Rheum. 1994;37:32-40
44.
Isomeri R.,Latikka M.,Latikka P..Effects of amitriptyline and cardiovascular fitness training on the pain of fibromyalgia patients.Scand J Rheumatol. 1992;94:47
45.
Goldenberg D. L.,Maysky M.,Mossey C..The independent and combined effect of fluoxetine and amitriptyline in the treatment of fibromyalgia.Arthritis Rheum. 1995;9:S229
46.
Jacox A.,Carr D. B.,Payne R..New clinical practice guidelines for management of pain in patients with cancer.N Eng J Med. 1994;330:651-5
47.
Ventafridda V.,Benezzi C.,Caraceni A..Antidepressants for cancer pain and other painful symptoms with deafferent components compared to amitriptyline and trazodone.Hal J Neurol Sci. 1987;8:579-87
48.
McQuay H. J.,Carroll D.,Glynn C. J..Low dose amitriptyline in the treatment of chronic pain.Anesthesia. 1992;47:646-52
49.
Merskey H.,Hester R. A..The treatment of chronic pain with psychotropic drugs.Post Grad Med J. 1972;48:594-8
50.
Duthie A. M..The use of phenothiazines and tricyclics in the treatment of intratable pain.S Afr Med J. 1977;51:246-7
51.
Dwight M. M.,Arnold L. M.,O'Brien H..An open trial of venlavaxine treatment of fibromyalgia.Psychosomatics. 1998;39:14-17
52.
Galer B. S..Neuropathic pain of peripheral origin: advances in pharmacologic treatment.Neurology. 1995;45 (supp 97): S17-25
