Antidepressants should be first-line approach for nerve tissue pain

New reviews of previous studies confirm that older-style antidepressants, as well as anticonvulsant drugs, can help ease the disabling pain caused by nerve tissue damage.

Often felt as a burning, tingling or stabbing sensation, neuropathic pain can result from nerve injuries or from conditions including chronically high blood sugar, complications from shingles or some cancer treatments.

For many years antidepressants, which are believed to work by dampening pain signals, have been the first-line drugs for neuropathic pain. "It is usual to start with an antidepressant like amitriptyline, and if this fails then try an anticonvulsant," says Phil Wiffen, a researcher at Churchill Hospital in Oxford, England. "The results of these meta-analyses suggest this is probably still the best approach to take."

Wiffen led several systematic evidence reviews on the effect of various antidepressants and anticonvulsives on pain, appearing in the current issue of the Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Wiffen and Tiina Saarto, M.D., analyzed 50 trials of 19 antidepressants, which involved more than 2,500 study participants. They found that tricyclic anti-depressants, particularly amitriptyline, can help ease the two most common types of neuropathic pain: from diabetes and shingles. The researchers recommend more studies of the effects of other antidepressants such as the newer selective serotonin reuptake inhibitors (SSRIs) and selective Norepinephrine Reuptake Inhibitors (SNRIs), as well as alternative medicines such as St. John's Wort, before they can be recommended for neuropathic pain.

These results on tricyclics may be encouraging but "antidepressants do not cure or totally eliminate all pain,

Contact: Phil Wiffen
Center for the Advancement of Health

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