Review of antidepressants in the treatment of neuropathic pain

Abstract Introduction Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. Trials indicate that venlafaxine, duloxetine, and tricyclic antidepressants (TCAs) have comparable efficacy, but TCAs have a higher incidence of adverse effects. Other antidepressants, such as citalopram, paroxetine, and bupropion have limited evidence supporting their use in neuropathy. Discussion Based on the evidence reviewed, venlafaxine and duloxetine should be used as first-line agents. TCAs should be used as second-line agents, due to higher incidence of adverse effects. Other treatment options include citalopram, paroxetine, and bupropion, but data supporting their efficacy is limited.

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Therapeutic Approaches for Peripheral and Central Neuropathic Pain

Behavioural Neurology ◽

10.1155/2019/8685954 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 5

Author(s):

Délia Szok ◽

János Tajti ◽

Aliz Nyári ◽

László Vécsei ◽

Luigi Trojano

Keyword(s):

Neuropathic Pain ◽

Tricyclic Antidepressants ◽

Treatment Options ◽

Somatosensory System ◽

Therapeutic Approaches ◽

Chronic Neuropathic Pain ◽

Central Neuropathic Pain ◽

Psychological Therapies ◽

First Choice ◽

Pubmed Search

Neuropathic pain is a chronic secondary pain condition, which is a consequence of peripheral or central nervous (somatosensory) system lesions or diseases. It is a devastating condition, which affects around 7% of the general population. Numerous etiological factors contribute to the development of chronic neuropathic pain. It can originate from the peripheral part of the nervous system such as in the case of trigeminal or postherpetic neuralgia, peripheral nerve injury, painful polyneuropathies, or radiculopathies. Central chronic neuropathic pain can develop as a result of spinal cord or brain injury, stroke, or multiple sclerosis. As first-line pharmacological treatment options, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids are recommended. In trigeminal neuralgia, carbamazepine and oxcarbazepine are the first-choice drugs. In drug-refractory cases, interventional, physical, and psychological therapies are available. This review was structured based on a PubMed search of papers published in the field from 2010 until May 2019.

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Efficacy and safety of evogliptin versus sitagliptin as add on to metformin alone in a combined russian-korean population. Evo-combi trial

Diabetes Mellitus ◽

10.14341/dm9586 ◽

2018 ◽

Vol 21 (4) ◽

pp. 241-254

Author(s):

Alina Y. Babenko ◽

Anna A. Mosikian ◽

Igor E. Makarenko ◽

Victoriya V. Leusheva ◽

Evgeny V. Shlyakhto

Keyword(s):

Glycemic Control ◽

Adverse Effects ◽

Safety Profile ◽

Randomized Clinical Trials ◽

Comparable Efficacy ◽

Efficacy And Safety ◽

South Korean ◽

Metformin Monotherapy ◽

Study Results ◽

Dipeptidyl Peptidase 4 Inhibitors

Background: Dipeptidyl-peptidase-4 inhibitors (iDPP-4) are pathogenically targeted drugs for diabetes mellitus type 2 (T2DM). Evogliptin is a new member of iDPP-4 class. The drug has the longest half-elimination period among the class, and its efficacy and safety as monotherapy have been already studied in placebo-controlled randomized clinical trials. Aims: To study efficacy and safety of evogliptin as compared to sitagliptin in T2DM patients with unsatisfying glycemic control with metformin monotherapy via a multinational double blind randomized controlled trial. To compare the study results in Russian and Korean subpopulations. Materials and methods: We used a combined Russian-Korean database (1:4) of EVO-COMBI trial. 281 adult T2DM patients administered metformin alone (at least 1000 mg/day) were randomized 1:1 to add on evogliptin (142 patients) or sitagliptin (139 patients) for 24 weeks once daily. The primary endpoint was change in glycated hemoglobin (HbA1c) level at Week 24 as compared to baseline. Non-inferiority was concluded if the upper limit of the 2-sided 95% confidence interval for the HbA1c difference between treatments was 0.35 %. Subgroup analysis for between-subpopulation difference in treatment effect was also conducted. Results: The mean between-group difference was 0.03 % [95 % CI: -0.14; 0.19 %], that confirms non-inferiority of evogliptin (mean HbA1c decrease -0.58 0.70 %, p0.001) to sitagliptin (mean HbA1c decrease -0.61 0.66 %, p0.001). Evogliptin and sitagliptin both tend to be more effective in South Korean subpopulation in terms of fasting plasma glucose lowering (p=0.030), however HbA1c decrease in subpopulations was comparable (p=0.657). Both drugs were well tolerated in both subpopulations. Adverse effects were associated mostly with gastrointestinal disorders, and the frequency was comparable between treatment groups (p0.05). Gastrointestinal adverse effects were registered more often in Korean patients (p=0.014). There were no severe hypoglycemia. Frequency of mild hypoglycemia was comparable between evogliptin and sitagliptin (0.7 % and 5.2 %, respectively, p=0.365). Conclusions: Evogliptin 5 mg/day is non-inferior to sitagliptin 100 mg/day in T2DM patients with unsatisfying glycemic control with metformin monotherapy. Safety profile is also comparable. Efficacy-safety profile of evogliptin is comparable in Russian and South Korean subpopulations.

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An overview of treatment options for COVID-19

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20204509 ◽

2020 ◽

Vol 9 (11) ◽

pp. 1770

Author(s):

Madhusmita Mohanty Mohapatra ◽

Manju Rajaram ◽

Dharm Prakash Dwivedi ◽

Vishnukant Govindraj ◽

Pratap Upadhya

Keyword(s):

Clinical Trials ◽

Randomized Clinical Trials ◽

Treatment Options ◽

Unknown Origin ◽

The Novel ◽

Clinical Trial Registry ◽

Repurposed Drugs ◽

Novel Coronavirus ◽

Meta Analyses ◽

Effective Drugs

Severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) which emerged in Wuhan initially as pneumonia of unknown origin in December 2019, later spread to whole world and became pandemic on 11th March, 2020. Many drugs have been proposed but are backed without clinical evidence. Scientific bodies are in the row to discover a reliable vaccine and effective drugs against the novel coronavirus. Many antiviral and anti-parasitic drugs which were thought to have some effect on Coronavirus disease 2019 (COVID-19) have been tried during the crisis but none have shown concrete evidence of action. Randomized clinical trials on the repurposed drugs are now registered under clinical trial registry to look at the safety profile and efficacy of the drugs to be used against SARS-CoV-2. Many meta-analyses are being conducted worldwide to frame evidence for the fight against this novel coronavirus. We are providing below a review of various drugs that have been tried for treatment of COVID-19 as well as different clinical trials which are underway.

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Efficacy of Adjunctive Treatments Added to Olanzapine or Clozapine for Weight Control in Patients with Schizophrenia: A Systematic Review and Meta-Analysis

The Scientific World JOURNAL ◽

10.1155/2015/970730 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Yun-Jung Choi

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Adverse Effects ◽

Weight Reduction ◽

Weight Control ◽

Randomized Clinical Trials ◽

Psychiatric Symptoms ◽

Meta Analysis ◽

Cochrane Central Register ◽

Meta Analyses

Objectives. This study was conducted to review systematically adjunctive treatments for weight reduction in patients with schizophrenia and compare efficacies of clinical trials through meta-analysis, so as to provide effective clinical guideline regarding weight control for patients taking atypical antipsychotics.Methods. Candidate clinical trials were identified through searching the Cochrane Central Register of Controlled Trials, PubMed, and PsycINFO. Fourteen randomized clinical trials were included for systematic review and meta-analysis from 132 potential trials. The Comprehensive Meta-Analysis version 2 was used for meta-analysis.Results. Difference in means and significances from meta-analyses regarding weight control by adjunctive treatments showed that topiramate, aripiprazole, or sibutramine was more effective than metformin or reboxetine. Psychiatric evaluations did not show statistically significant changes between treatment groups and placebo groups except topiramate adjunctive treatments. Adverse effects regarding adjunctive therapies were tolerable and showed statistically no significances compared to control groups.Conclusion. Though having several reports related to exacerbation of psychiatric symptoms, topiramate and aripiprazole are more efficacious than other medications in regard to weight reduction and less burden of critical adverse effects as well as being beneficial for clinical improvement.

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Design Features of Randomized Clinical Trials of Vitamin D and Falls: A Systematic Review

Nutrients ◽

10.3390/nu10080964 ◽

2018 ◽

Vol 10 (8) ◽

pp. 964 ◽

Cited By ~ 5

Author(s):

Olive Tang ◽

Stephen Juraschek ◽

Lawrence Appel

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Randomized Clinical Trials ◽

Vitamin D Supplementation ◽

Design Features ◽

Highly Sensitive ◽

Pubmed Search ◽

Falls In Older Adults ◽

Vitamin D Supplements ◽

Meta Analyses

Recent guidelines have advocated against the use of vitamin D supplementation as a means to prevent falls in older adults. However, meta-analyses of the available trials have reached divergent conclusions, and the key design features of these trials have not been well characterized. We conducted a systematic review of 30 randomized trials that reported the effects of vitamin D supplements on falls. Trials were identified by reviewing references of published meta-analyses and updated with a systematic PubMed search. We assessed three key design features: (1) recruitment of participants with vitamin D deficiency or insufficiency; (2) provision of daily oral vitamin D supplementation; and (3) utilization of highly sensitive at-event falls ascertainment. The trials enrolled a median of 337 (IQR: 170-1864) participants. Four (13.3%) trials restricted enrollment to those who were at least vitamin D insufficient, 18 (60.0%) included at least one arm providing daily supplementation, and 16 (53.3%) used at-event reporting. There was substantial heterogeneity between trials, and no single trial incorporated all three key design features. Rather than concluding that vitamin D is ineffective as a means to prevent falls, these findings suggest that existing trial evidence is insufficient to guide recommendations on the use of vitamin D supplements to prevent falls.

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An overview of analgesics - anticonvulsants, antidepressants, and other medications (Part 3)

South African Family Practice ◽

10.4102/safp.v61i3.4972 ◽

2019 ◽

Vol 61 (3) ◽

pp. 59-63

Author(s):

R. Van Rensburg ◽

H. Reuter

Keyword(s):

Chronic Pain ◽

Nervous System ◽

Neuropathic Pain ◽

Tissue Damage ◽

Tricyclic Antidepressants ◽

Treatment Options ◽

First Line ◽

Patient Profile ◽

Noradrenaline Reuptake ◽

Associated Conditions

Pain is classified by various descriptions. Chronic pain has been described as being neuropathic (due to nervous system lesions), nociceptive (due to tissue damage), or mixed (a combination of neuropathic and nociceptive). The addition of the term nociplastic pain is used to describe patients who experience chronic pain without tissue damage or nervous system lesions. Chronic pain is often difficult to manage, particularly neuropathic pain. Evidence-based pharmacological treatment options include anticonvulsants and antidepressants. The choice of medication will depend on various factors, including patient profile, type of pain, and associated conditions. Medications with the best evidence of efficacy for first-line use in neuropathic pain are the gabapentinoids, carbamazepine, the tricyclic antidepressants, and the serotonin-noradrenaline reuptake inhibitors duloxetine and venlafaxine. The cannabinoids and ketamine are being actively investigated for use in chronic pain. Currently the cannabinoids’ potential benefit is outweighed by the adverse effects, and recommendations for the use of ketamine is limited by its parenteral route of administration and low evidence of efficacy in chronic pain.

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Barriers and Facilitators to Optimal Neuropathic Pain Management: SCI Consumer, Significant Other, and Health Care Provider Perspectives

Pain Medicine ◽

10.1093/pm/pnaa058 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2913-2924

Author(s):

Eva Widerstrom-Noga ◽

Kim D Anderson ◽

Salome Perez ◽

Alberto Martinez-Arizala ◽

Lindsey Calle-Coule ◽

...

Keyword(s):

Health Care ◽

Neuropathic Pain ◽

Pain Management ◽

Adverse Effects ◽

Qualitative Interviews ◽

Treatment Options ◽

Significant Others ◽

Barriers And Facilitators ◽

Care Providers ◽

Nonpharmacological Treatment

Abstract Objective Persistent neuropathic pain is a common and often severe consequence of spinal cord injury (SCI). There is a critical need to better understand how to overcome barriers and promote facilitators to optimal pain management. The present study was designed to identify, from the perspectives of persons living with SCI, their significant others, and SCI health care professionals, the barriers and facilitators to optimal pain management for intense neuropathic pain. Design Qualitative interviews. Setting University laboratory. Subjects People with SCI who had experienced intense neuropathic pain for a minimum of a year (N = 15), their significant others (N = 15), and SCI health care providers (N = 15). Methods Qualitative interviews were recorded, transcribed, and analyzed based on grounded theory using ATLAS.ti software. Results Inadequate access to care, information, or pain management expertise were frequently perceived barriers to optimal pain management across all three groups. Another major barrier was SCI stakeholders’ concerns regarding the risks of adverse effects and addiction to pain medication. Facilitators included having a better understanding of pain and available treatment options, effective patient–provider communication, resilience, and access to nonpharmacological treatment options. Conclusions Managing intense neuropathic pain poses significant challenges after SCI. SCI stakeholders felt that accessible treatment options were limited and primarily focused on pain medications with minimal benefit but with significant risks for addiction and adverse effects. Actionable facilitators to optimal pain management after SCI include education regarding neuropathic pain and treatment options for all stakeholders, better communication regarding neuropathic pain among stakeholders, and improved patient access to nonpharmacological treatment options.

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An Updated Overview of Low Back Pain Management in Primary Care

Asian Spine Journal ◽

10.4184/asj.2017.11.4.653 ◽

2017 ◽

Vol 11 (4) ◽

pp. 653-660 ◽

Cited By ~ 13

Author(s):

Jae-Young Hong ◽

Kwang-Sup Song ◽

Jae Hwan Cho ◽

Jae Hyup Lee

Keyword(s):

Back Pain ◽

Systematic Reviews ◽

Randomized Clinical Trials ◽

Treatment Options ◽

Pharmacological Therapy ◽

Quality Data ◽

Cochrane Central Register ◽

High Quality ◽

Korean Society ◽

Meta Analyses

<p>Currently, guidelines for lower back pain (LBP) treatment are needed. We reviewed the current guidelines and high-quality articles to confirm the LBP guidelines for the Korean Society of Spine Surgery. We searched available databases for high-quality articles in English on LBP published from 2000 to the present year. Literature searches using these guidelines included studies from MEDLINE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Embase. We analyzed a total of 132 randomized clinical trials, 116 systematic reviews, 9 meta-analyses, and 4 clinical guideline reviews. We adopted the SIGN checklist for the assessment of article quality. Data were subsequently abstracted by a reviewer and verified. Many treatment options exist for LBP, with a variety of recommendation grades. We assessed the recommendation grade for general behavior, pharmacological therapy, psychological therapy, and specific exercises. This information should be helpful to physicians in the treatment of LBP patients.</p>

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Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence

Therapeutic Advances in Drug Safety ◽

10.1177/2042098617715381 ◽

2017 ◽

Vol 8 (9) ◽

pp. 273-297 ◽

Cited By ~ 69

Author(s):

Marina L. Maes ◽

Danielle R. Fixen ◽

Sunny Anne Linnebur

Keyword(s):

Older Adults ◽

Adverse Effects ◽

Proton Pump ◽

Vitamin B12 Deficiency ◽

Community Acquired Pneumonia ◽

Increased Risk ◽

Pubmed Search ◽

Post Marketing ◽

Meta Analyses

Proton-pump inhibitors (PPIs) are a widely prescribed class of medications used to treat acid-related disorders and use has significantly increased over the last few decades. PPIs are often inappropriately prescribed and since they have been on the market, a number of post-marketing studies have been published demonstrating associations between longer duration of PPI therapy and a number of adverse effects that are a concern in older adults. The objective of this review is to discuss the existing literature of potential adverse effects with long-term PPI use in older adults and to summarize the implications in clinical practice. A PubMed search was conducted to identify studies evaluating the potential long-term adverse effects of PPI therapy in older adults, and publications were selected based on relevant criteria. PPIs have been associated with an increased risk of a number of adverse effects including osteoporotic-related fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin B12 deficiency, kidney disease, and dementia, demonstrated by a number of case-control, cohort studies, and meta-analyses. Older adults should be periodically evaluated for the need for continued use of PPI therapy given the number of potential adverse effects associated with long-term use.

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Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis

Multiple Sclerosis International ◽

10.1155/2015/317859 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Georg Anton Giæver Beiske ◽

Trygve Holmøy ◽

Antonie Giæver Beiske ◽

Svein I. Johannessen ◽

Cecilie Johannessen Landmark

Keyword(s):

Multiple Sclerosis ◽

Neuropathic Pain ◽

Retrospective Study ◽

Adverse Effects ◽

Medical Records ◽

Tricyclic Antidepressants ◽

Rehabilitation Centre ◽

Pharmacodynamic Interactions ◽

High Prevalence ◽

Antidepressive Drugs

Objective. Patients with multiple sclerosis (MS) are often suffering from neuropathic pain. Antiepileptic drugs (AEDs) and tricyclic antidepressants (TCAs) are commonly used and are susceptible to be involved in drug interactions. The aim of this retrospective study was to investigate the prevalence of use of antiepileptic and antidepressive drugs in MS patients and to discuss the theoretical potential for interactions.Methods. Review of the medical records from all patients treated at a dedicated MS rehabilitation centre in Norway between 2009 and 2012.Results. In total 1090 patients attended a rehabilitation stay during the study period. Of these, 342 (31%; 249 females) with mean age of 53 (±10) years and EDSS 4.8 (±1.7) used at least one AED (gabapentin 12.7%, pregabalin 7.7%, clonazepam 7.8%, and carbamazepine 2.6%) or amitriptyline (9.7%). Polypharmacy was widespread (mean 5.4 drugs) with 60% using additional CNS-active drugs with a propensity to be involved in interactions. Age, gender, and EDSS scores did not differ significantly between those using and not using AED/amitriptyline.Conclusion. One-third of MS patients attending a rehabilitation stay receive AED/amitriptyline treatment. The high prevalence of polypharmacy and use of CNS-active drugs calls for awareness of especially pharmacodynamic interactions and possible excessive adverse effects.

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