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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2002 March;68(3):105-14

language: English

New antidepressants in the treatment of neuropathic pain. A review

Mattia C., Paoletti F. *, Coluzzi F., Boanelli A. **

From the Insti­tute of Anaesthe­sio­lo­gy and Inten­sive ­Care Med­i­cine Uni­ver­sity of Stud­ies La Sapien­za - ­Rome
*Depart­ment of Clin­i­cal and Experi­men­tal Med­i­cine Depart­ment of Anaesthe­sia Anal­ge­sia and Inten­sive ­Care Med­i­cine, ­Pain ­Unit Uni­ver­sity of Stud­ies - Peru­gia


­Before 1980s, tri­cy­clics (­TCAs) ­were con­sid­ered, ­between anti­de­press­ants, the stan­dard in the treat­ment of dif­fer­ent ­kinds of neu­ro­path­ic ­pain, for ­their ­action on norad­re­ner­gic and ser­o­ton­i­ner­gic path­ways, ­thought the ­high inci­dence of ­side ­effects. In 1980s a new ­class of anti­de­press­ants has ­been intro­duced, the selec­tive serot­o­nin reup­take inhib­i­tors (­SSRI). We ­reviewed ­some pub­li­ca­tions, includ­ing ­trials com­par­ing ­SSRIs ­with ­TCAs in ­pain man­age­ment. The avail­able lit­er­a­ture did not ­show an effec­tive super­ior­ity of the for­mer on the lat­ter, ­though ­improved ­side-­effect pro­file. Recent­ly new anti­de­press­ants ­were intro­duced in the clin­i­cal use, ­with a sig­nif­i­cant reduc­tion in ­side ­effects and equiv­a­lent effi­ca­cy on ­mood dis­or­ders. ­These new ­drugs may be clas­si­fied in ­three cat­e­go­ries: Serot­o­nin and Norad­re­ner­gic Reup­take Inhib­i­tors (SNa­RI), ­like ven­la­fax­ine and nefaz­o­done; Norad­re­ner­gic and Spe­cif­ic Ser­o­ton­i­ner­gic Anti­de­press­ants (NaS­SA), ­like mir­taz­a­pine, and Nor­a­dren­a­line Reup­take Inhib­i­tors (­NaRI), ­like rebox­e­tine. In ­this ­review we ­present the avail­able pub­li­ca­tions of ­their appli­ca­tion in the treat­ment of neu­ro­path­ic ­pain. Ven­la­fax­ine (SNa­RI), the ­most inves­ti­gat­ed of ­these new ­drugs, was ­shown to be effec­tive in the treat­ment of dif­fer­ent ­kinds of ­pain, ­with ­side-­effects pro­file sig­nif­i­cant­ly bet­ter ­than ­TCAs. The oth­er new anti­de­press­ants ­have ­been ­less exten­sive­ly stud­ied, ­thus ­only anec­do­tal ther­a­peu­tic ­results and experi­men­tal ­works ­have ­been ­found and report­ed. Exist­ing ­data are sure­ly insuf­fi­cient to con­clude ­which of ­these new class­es of ­drugs has the ­best clin­i­cal pro­file and can be ­more effec­tive in the treat­ment of neu­ro­path­ic ­pain, but the low­er inci­dence of ­side ­effects ­should be con­sid­ered. Fur­ther evi­dence-­based ­research in the safe­ty and effi­ca­cy of ­these prom­is­ing ­agents in ­pain ­relief, is war­rant­ed.

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