Effects of Desipramine, Amitriptyline, and Fluoxetine on Pain in Diabetic Neuropathy

Max, Mitchell B.; Lynch, Sue; Muir, Joanne; Shoaf, Susan E.; Smoller, Bruce M; Dubner, Ronald

doi:10.1056/nejm199205073261904

Cited by 1,026 publications

(428 citation statements)

References 30 publications

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“…Despite the proven efficacy of FL and other selective serotonin uptake inhibitors in the treatment of mood disturbances, their efficacy as analgesics has not been established. For example, FL was not better than placebo in the treatment of pain associated with diabetic neuropathy, although AM and desipramine were effective as analgesics (28). We found that the improvement in FM pain resulting from treatment with 20 mg of FL was comparable to that with 25 mg of AM.…”

Section: Discussionmentioning

confidence: 61%

A randomized, double‐blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia

Goldenberg

Mayskiy

Mossey

et al. 1996

Arthritis & Rheumatism

372

190

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Objective. To study the effect of fluoxetine (FL) and amitriptyline (AM), alone and in combination, in patients with fibromyalgia (FM).Methods. Nineteen patients with FM completed a randomized, double-blind crossover study, which consisted of 4 6-week trials of FL (20 mg), AM (25 mg), a combination of FL and AM, or placebo. Patients were evaluated on the first and last day of each trial period. Outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI) scale, and visual analog scales PAS) for global well-being (1 completed by the physican and 1 by the patient), pain, sleep trouble, fatigue, and feeling refreshed upon awakening.Results. Both FL and AM were associated with significantly improved scores on the FIQ and on the VAS €or pain, global well-being, and sleep disturbances. When combined, the 2 treatments worked better than either medication alone. Similar, but nonsignificant, improvement occurred in the BDI scale, the physician global VAS, and the VAS for fatigue and feeling refreshed upon awakening. Trends were less clear for the tender point score.Conclusion. Both FL and AM are effective treatments for FM, and they work better in combination than either medication alone.Clinical trials of medications for the treatment of fibromyalgia (FM) have demonstrated modest or little efficacy. Tricyclic and tetracyclic "antidepressant" drugs

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Section: Discussionmentioning

confidence: 61%

A randomized, double‐blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia

Goldenberg

Mayskiy

Mossey

et al. 1996

Arthritis & Rheumatism

372

190

View full text Add to dashboard Cite

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“…Max et al found that, except in depressed patients, fluoxetine produced no more improvement in pain than placebo. 16 However, Sindrup et al found a significant improvement in patients treated with either paroxetine or citalopram versus placebo. [17][18][19] A possible explanation is that serum levels of the treatment drugs were higher in the Sindrup et al studies.…”

Section: Discussionmentioning

confidence: 99%

“…Max et al compared amitriptyline with desipramine, and fluoxetine with placebo in concurrent, randomized, double-blind, crossover studies. 16 Compared with the placebo group, they found significant and equivalent pain relief in the groups treated with amitriptyline and desipramine ( p Ͻ .05), but no significant improvement in the group receiving fluoxetine ( p ϭ .34).…”

Section: Neuropathymentioning

confidence: 94%

The Efficacy of Selective Serotonin Reuptake Inhibitors for the Management of Chronic Pain

1997

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OBJECTIVE:To assess the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the management of chronic pain. METHODS:Randomized, controlled trials of SSRIs in the management of chronic pain were identified by searching MEDLINE from 1966 to 1997 and by contacting the manufacturers of SSRIs available in the United States. MAIN RESULTS:Nineteen studies were identified, including 10 on the treatment of headache, 3 on diabetic neuropathy, 3 on fibromyalgia, and 3 on mixed-chronic pain. SSRIs were consistently helpful for mixed-chronic pain. Results were conflicting for migraine headache, tension headache, diabetic neuropathy, and fibromyalgia. T he clinical management of chronic pain remains a challenge. Despite advances in pain research and clinical treatment, rates of disability due to chronic pain continue to climb worldwide. 1 Although chronic pain is treated with many medications, such as tricyclic antidepressants, nonsteroidal anti-inflammatory drugs, anticonvulsants, and opioids, none has shown outstanding efficacy. Narcotics are usually avoided because of the risk of developing tolerance, dependence, and functional deterioration. 2 Tricyclic antidepressants have proven efficacy in the treatment of chronic pain conditions such as diabetic neuropathy, fibromyalgia, chronic headaches, and post-herpetic neuralgia. 3 Their ability to relieve pain in these conditions appears to be independent of their antidepressant effect and may be related to their effect on neuronal reuptake of serotonin and norepinephrine. Unfortunately, side effects including dry mouth, constipation, orthostatic hypotension, and urinary retention often limit their use. CONCLUSIONS:Fluoxetine was introduced as the first selective serotonin reuptake inhibitor (SSRI) in the United States in 1988. Since then, SSRIs have become the most frequently prescribed antidepressant medications owing to their favorable side-effect profile. 4 More than half of antidepressant prescriptions written in the primary care setting are for conditions other than depression. 5 There is considerable interest in the use of SSRIs for the management of chronic pain, although they are not currently approved by the Food and Drug Administration for this purpose. This review summarizes available data on the value of these medications for pain control in several clinical situations. METHODSWe used the National Library of Medicine search engine to search MEDLINE from 1966 to 1997 using the medical subject heading (MeSH) term "pain," exploding it, and adding the following words in all fields: pain, neuropathy, migraine, and fibromyalgia. We also searched using the MeSH term "serotonin uptake inhibitors" and the following words in all fields: sertraline, paroxetine, fluoxetine, fluvoxamine, femoxetine, zimelidine, and citalopram. We combined results of these two searches with the term "and," and selected for review randomized double-blind, controlled studies published in English and performed on humans. References from studies reviewed provided additional sources of...

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“…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. 13 In a crossover study comparing 4-week treatment periods, venlafaxine and imipramine were found to be superior to placebo in relieving DPNP. 14 Other drugs reported to manage DPNP are "anticonvulsants," 15,16 selective serotonin reuptake inhibitors, 17 controlled-release oxycodone, 18,19 and the synthetic cannabinoid CT-3.…”

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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Effects of Desipramine, Amitriptyline, and Fluoxetine on Pain in Diabetic Neuropathy

Cited by 1,026 publications

References 30 publications

A randomized, double‐blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia

A randomized, double‐blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia

The Efficacy of Selective Serotonin Reuptake Inhibitors for the Management of Chronic Pain

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

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