Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa

Pharmacological treatment of painful HIV-associated sensory neuropathy

“…In most cases the tricyclic antidepressant amitriptyline was included in the analgesic regimen, consistent with national guidelines. [6,7] We found significant associations, of moderate size, between pain intensity and analgesic therapy as well as between CD4 T-cell count and analgesic therapy; subjects with more severe pain and those with lower CD4 T-cell counts were more likely to be receiving treatment. However, greater pain was not associated with analgesic dose used, and lower CD4 T-cell counts were not associated with pain intensity.…”

“…While there is no evidence that amitriptyline is more effective than placebo for painful HIV-SN, [11][12][13] its proven efficacy in other types of neuropathic pain [22] prompted an expert panel to recommend it as a first-line option for HIV-SN pain in SA. [7] These patients were therefore receiving a recommended treatment, albeit at a relatively low dose (25 -50 mg/d). [7] Amitriptyline was commonly used in combination with codeine and paracetamol.…”

“…[7] These patients were therefore receiving a recommended treatment, albeit at a relatively low dose (25 -50 mg/d). [7] Amitriptyline was commonly used in combination with codeine and paracetamol. Neither of these drugs have proven efficacy in neuropathic pain, [22] but their use may reflect concurrent sources of pain (common in HIV) that may be responsive to standard opioid and non-opioid analgesics and non-steroidal antiinflammatory agents.…”

“…[1][2][3] Painful HIV-SN is associated with substantially reduced health-related quality of life, [2] but evidence-based analgesic options are lacking. [4] Several national and international agencies [5][6][7][8][9][10] have recommended the tricyclic antidepressant amitriptyline for HIV-SN pain, despite evidence that this is no better than placebo. [11,13] Despite the high prevalence [1,2] and considerable impact of HIV-SN, and the lack of proven effective analgesics, few data exist describing the frequency, type and dosage of pain medication patients are receiving.…”

Challenges of Pain Medicine: The Stigma Associated with using Tri-Cyclical Anti-Depressants – It’s not all in the Mind

“…There were no significant safety findings; however, surprisingly there were a significantly higher number of adverse events in the pregabalin treatment group [6].…”