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Pain generated by damage to the nervous system can be treated with antidepressants
Jul 20, 2005, 15:07, Reviewed by: Dr.
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The most convincing evidence was for amitriptyline in doses up to 150mg per day, which achieved at least moderate pain relief. It was difficult to assess the value of selective serotonin reuptake inhibitors (SSRIs) as there are few trials in neuropathic pain. The Cochrane Review Authors also found that there was insufficient high quality evidence for them to draw any conclusions about St John's Wort, venlafaxine and L-tryptophan.
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By Cochrane Library,
Antidepressant drugs such as amitriptyline are effective against a variety of neuropathic pains.
Neuropathic pains result when injury or disease causes damage to the nervous system. These pains can last for months or years after any injury has healed. The damage may be in peripheral nerves that run through the body and limbs, or within the central nervous system in the spine or brain. Patients with this form of pain are frequently given antidepressant drugs, and researchers who have assessed the findings of 50 trials conducted around the world conclude that there is good evidence that at least some of them work well.
The most convincing evidence was for amitriptyline in doses up to 150mg per day, which achieved at least moderate pain relief. It was difficult to assess the value of selective serotonin reuptake inhibitors (SSRIs) as there are few trials in neuropathic pain. The Cochrane Review Authors also found that there was insufficient high quality evidence for them to draw any conclusions about St John's Wort, venlafaxine and L-tryptophan.
"The clinical impression is that antidepressants are effective and this review confirms this belief," said lead author Tiina Saarto who works in Helsinki University Central Hospital, Helsinki, Finland. "If the drug is going to be affective, it normally starts to reduce pain within a few days of starting to take it."
Antidepressants had most effect treating diabetic neuropathy and post-herpetic neuralglia. There was limited evidence that they could also help people with central pain, atypical facial pain and pain after breast cancer treatment. There was a lack of evidence that they helped people with HIV-related neuropathic pain or 'burning mouth syndrome'. 
- Review Title: Saarto et al: Antidepressants for neuropathic pain. The Cochrane Database of Systematic Reviews 2005 Issue 3
www.interscience.wiley.com
Cochrane reviews are based on the best available information about healthcare interventions. They explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances.
The complete reviews are published in The Cochrane Library which is available by subscription, either on CDROM or via the Internet. You should be able to browse the Cochrane Library at your nearest medical library if you don't have your own subscription.
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