Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial

Max, Mitchell B.; Kishore-Kumar, Ranganna; Schafer, Susan; Meister, Blanche; Gracely, Richard H.; Smoller, Bruce M; Dubner, Ronald

doi:10.1016/0304-3959(91)90157-s

Cited by 280 publications

(128 citation statements)

References 28 publications

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“…20, [40][41][42] Several studies have documented that the analgesic effect is independent of the antidepressant effect and that these agents are effective in patients with persistent pain who do not have concurrent depression. [43][44][45] Also it has been observed that analgesic action is strongest in antidepressants with mixedreceptor or predominantly noradrenergic activity. 46,47 …”

Section: Antidepressants As Analgesicsmentioning

confidence: 99%

Efficacy of Antidepressants as Analgesics: A Review

Dharmshaktu¹,

Tayal²,

Kalra³

2012

The Journal of Clinical Pharma

278

189

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Persistent pain disorders are usually not adequately alleviated by nonsteroidal anti‐inflammatory drugs or other simple analgesics. Use of antidepressants as adjuvant therapy for the control of persistent pain is currently being practiced in disorders such as fibromyalgia, neuropathic pain, rheumatoid conditions, low back pain, and headache. This review describes the various mechanisms of analgesic activity of antidepressants along with their efficacy and tolerability profiles. Meta‐analyses and clinical studies of these agents were retrieved through the use of MEDLINE, Google scholar, and Cochrane databases. Antidepressants are effective in both neuropathic and non‐neuropathic pain and have diverse mechanisms independent of their antidepressant effects. Tricyclic antidepressants (amitryptiline, nortryptiline, desipramine) are effective compounds in the treatment of neuropathic pain, fibromyalgia, low back pain, and headaches. Studies are ongoing for the dual serotonin norepinephrine reuptake inhibitors (duloxetine, venlafaxine) in several persistent pain conditions and these may be recommended in neuropathic pain, migraines, and fibromyalgia. Evidence suggests that although the analgesic effects of selective serotonin reuptake inhibitors (fluoxetine, paroxetine, citalopram) are limited and inconsistent, yet they have a superior tolerability profile compared with tricyclic antidepressants.

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Section: Antidepressants As Analgesicsmentioning

confidence: 99%

Efficacy of Antidepressants as Analgesics: A Review

Dharmshaktu¹,

Tayal²,

Kalra³

2012

The Journal of Clinical Pharma

278

189

View full text Add to dashboard Cite

show abstract

“…Examples include efficacy of alleviating neuropathic pain behavior in rat models of DPN using tricyclic antidepressants [52,53,55,56] and morphine [55]. Clinical trials demonstrating efficacy with tricyclic antidepressants [57][58][59][60][61] and opioids [62,63] provide further validation of the usefulness of these outcome measures.…”

Section: Diabetic Neuropathymentioning

confidence: 99%

Animal Models of Peripheral Neuropathies

Höke

2012

Neurotherapeutics

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Peripheral neuropathies are common neurological diseases, and various animal models have been developed to study disease pathogenesis and test potential therapeutic drugs. Three commonly studied disease models with huge public health impact are diabetic peripheral neuropathy, chemotherapy-induced peripheral neuropathy, and human immunodeficiency virus-associated sensory neuropathies. A common theme in these animal models is the comprehensive use of pathological, electrophysiological, and behavioral outcome measures that mimic the human disease.

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“…10 Tricyclic antidepressants (TCAs) with reuptake inhibitory activity for both 5-HT and NE have been widely used in the management of DPNP. 11,12 Hypothetically, dual reuptake inhibitors unburdened by the undesirable pharmacologic effects of TCAs should be better tolerated and more effective in managing diabetic peripheral neuropathic pain (DPNP). This hypothesis is supported by the finding that amitriptyline (5-HT and NE reuptake inhibitor) is superior to desipramine (NE reuptake inhibitor), which is superior to fluvoxamine (5-HT reuptake inhibitor) in providing pain relief.…”

Section: Introduction Dmentioning

confidence: 99%

Duloxetine versus Routine Care in the Long-Term Management of Diabetic Peripheral Neuropathic Pain

Raskin

Smith

Wong³

et al. 2006

Journal of Palliative Medicine

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Introduction: Duloxetine hydrochloride is a dual reuptake inhibitor of both serotonin and norepinephrine. In the present open-label study, the safety of duloxetine at a fixed-dose of 60 mg twice daily (BID) for up to 52 weeks was evaluated and compared to routine care in the therapy of patients diagnosed with diabetic peripheral neuropathic pain (DPNP).Methods: Patients who completed a 13-week, double-blind, duloxetine and placebo acute therapy period were rerandomly assigned in a 2:1 ratio to therapy with duloxetine 60 mg BID (N ‫؍‬ 161) or routine care (N ‫؍‬ 76) for an additional 52 weeks. Routine care consisted primarily of gabapentin, amitriptyline, and venlafaxine. The study included male or female outpatients 18 years of age or older with a diagnosis of DPNP caused by type 1 or type 2 diabetes.Results: A higher percentage of routine care-treated patients experienced 1 or more serious adverse events. No statistically significant therapy-group difference was observed in the overall incidence of treatment-emergent adverse events (TEAEs). The TEAEs reported by 10% or more of duloxetine 60 mg BID-treated patients were nausea, and by the routine care-treated patients were peripheral edema, pain in the extremity, somnolence, and dizziness. Duloxetine did not appear to adversely affect glycemic control, lipid profiles, nerve function, or the course of DPNP. There were no statistically significant therapy-group differences observed in the 36-item Short-Form Health Survey subscales or in the EuroQol 5-Dimension Questionnaire.Conclusions: In this study, duloxetine was safe and well tolerated compared to routine care in the long-term management of patients with DPNP.

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Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial

Cited by 280 publications

References 28 publications

Efficacy of Antidepressants as Analgesics: A Review

Efficacy of Antidepressants as Analgesics: A Review

Animal Models of Peripheral Neuropathies

Duloxetine versus Routine Care in the Long-Term Management of Diabetic Peripheral Neuropathic Pain

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