Abstract
Antidepressant drugs have been widely used for many years to treat neuropathic pain, despite the rationale for their use was still unclear. We review recent insights into their mechanism of action, focusing on central and peripheral analgesic actions. Beside the traditional monoaminergic hypothesis, other pharmacological actions have been studied: antidepressants interfere with the opioid system, interact with the NMDA receptors, and inhibit ion channel activity. Firm evidence from randomised controlled trials demonstrated that TCAs are the most effective drugs for treatment of different neuropathic pain conditions. They exhibit the lowest number needed to treat compare with all other drugs investigated. SSRIs failed to provide an adequate analgesia, due to their high selectivity. SSRIs are clearly less effective than TCAs (NNT: 6.7 vs 2.4) supporting the hypothesis that a balanced inhibition of noradrenaline and serotonin reuptake is more effective in relieving pain. On the basis of initial results Venlafaxine seems to be the most promising of the newer antidepressants as analgesic. Newer antidepressants show a better side effects profile, but further investigation are warranted to clarify their potential role in management of pain. Neuropathic pain remains a challenging condition to treat, as all currently available drugs fail to achieve adequate pain relief in a significant proportion of patients. TCAs should be currently considered the first choice in treatment of neuropathic pain and the gold standard against which to compare other potential new treatments.
Keywords: neuropathic pain, antidepressants, newer antidepressants, antinociception, analgesia, mechanism of action, venlafaxine, mirtazapine
Current Pharmaceutical Design
Title: Mechanism-Based Treatment in Chronic Neuropathic Pain: The Role of Antidepressants
Volume: 11 Issue: 23
Author(s): F. Coluzzi and C. Mattia
Affiliation:
Keywords: neuropathic pain, antidepressants, newer antidepressants, antinociception, analgesia, mechanism of action, venlafaxine, mirtazapine
Abstract: Antidepressant drugs have been widely used for many years to treat neuropathic pain, despite the rationale for their use was still unclear. We review recent insights into their mechanism of action, focusing on central and peripheral analgesic actions. Beside the traditional monoaminergic hypothesis, other pharmacological actions have been studied: antidepressants interfere with the opioid system, interact with the NMDA receptors, and inhibit ion channel activity. Firm evidence from randomised controlled trials demonstrated that TCAs are the most effective drugs for treatment of different neuropathic pain conditions. They exhibit the lowest number needed to treat compare with all other drugs investigated. SSRIs failed to provide an adequate analgesia, due to their high selectivity. SSRIs are clearly less effective than TCAs (NNT: 6.7 vs 2.4) supporting the hypothesis that a balanced inhibition of noradrenaline and serotonin reuptake is more effective in relieving pain. On the basis of initial results Venlafaxine seems to be the most promising of the newer antidepressants as analgesic. Newer antidepressants show a better side effects profile, but further investigation are warranted to clarify their potential role in management of pain. Neuropathic pain remains a challenging condition to treat, as all currently available drugs fail to achieve adequate pain relief in a significant proportion of patients. TCAs should be currently considered the first choice in treatment of neuropathic pain and the gold standard against which to compare other potential new treatments.
Export Options
About this article
Cite this article as:
Coluzzi F. and Mattia C., Mechanism-Based Treatment in Chronic Neuropathic Pain: The Role of Antidepressants, Current Pharmaceutical Design 2005; 11 (23) . https://dx.doi.org/10.2174/1381612054864993
DOI https://dx.doi.org/10.2174/1381612054864993 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Ruthenium as an Effective Nitric Oxide Scavenger
Current Topics in Medicinal Chemistry In Vitro, In Vivo and In Silico Analysis of the Anticancer and Estrogen-like Activity of Guava Leaf Extracts
Current Medicinal Chemistry Aryltetralin-type Lignan of Podophyllum: A Comprehensive Review
The Natural Products Journal Genetic Diversity Among Saudi Peganum harmala and Rhazya stricta Populations Using Chemical and ISSR Markers
Current Pharmaceutical Biotechnology The Influence of Genetic Variations and Drug Interactions Based on Metabolism of Antidepressants and Anticonvulsants
Current Drug Metabolism Defining Pharmacokinetics for Individual Patient Dosimetry in Routine Radiopeptide and Radioimmunotherapy of Cancer: Australian Experience
Current Pharmaceutical Design Histamine as a Potential Adjuvant to Immuno and Radiotherapy for Cancer Treatment: Discovering New Functions for the Oldest Biogenic Amine
Current Immunology Reviews (Discontinued) Interaction Between Bone and Muscle in Older Persons with Mobility Limitations
Current Pharmaceutical Design Overlooked Issues of Snakebite Management: Time for Strategic Approach
Current Topics in Medicinal Chemistry Cardiac Complications Attributed to Hydroxychloroquine: A Systematic Review of the Literature Pre-COVID-19
Current Cardiology Reviews Enhanced Anticancer Activity and Apoptosis Effect of Bioactive Compound Quercetin Extracted from <i>Ocimum sanctum</i> Leaves
Current Nanomedicine Application of Dual-Source CT Coronary Angiography in Type 2 Diabetic Patients with Symptomatic Coronary Heart Disease
Current Vascular Pharmacology Rho Kinase Inhibitors and Novel Ocular Drug Delivery Systems- A Revolutionary Step Towards the Treatment of Glaucoma
Current Drug Delivery Obesity and Gastrointestinal Hormones-Dual Effect of Angiotensin II Receptor Blockade and a Partial Agonist of PPAR-γ
Current Vascular Pharmacology The Inflammatory Response in Cardiac Surgery: An Overview of the Pathophysiology and Clinical Implications
Inflammation & Allergy - Drug Targets (Discontinued) Prophylactic Neuroprotection
Current Drug Targets Novel Metal Nanoparticles Stabilized with (2R,4R)-2,4-bis(diphenylphosphino) Pentane on SiO2. Their Use as Catalysts in Enantioselective Hydrogenation Reactions
Current Organic Chemistry An Improved Synthesis of m-Hydroxymexiletine, a Potent Mexiletine Metabolite
Drug Metabolism Letters Cerebrovascular Complications After Heart Transplantation
Current Cardiology Reviews Neuroprotection by Diazoxide in Animal Models for Cerebrovascular Disorders
Vascular Disease Prevention (Discontinued)