Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain

Özmen, Mehmet Cüneyt; Dieckmann, G; Cox, Stephanie; Rashad, Ramy; Paracha, Rumzah; Sanayei, Nedda; Morkin, Melina I.; Hamrah, Pedram

doi:10.1016/j.jtos.2020.08.006

Cited by 21 publications

(19 citation statements)

References 45 publications

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“…In addition, quality of life score (via an OPAS sub-score) improved from 6.0 ± 2.5 to 4.3 ± 2.4 (p=0.019). 103 Taken together, the above studies suggest that in individuals with dry eye symptoms and clinical features suggestive of central nerve abnormalities, oral nerve modulators may improve ocular pain symptoms. However, in patients with either dry eye or migraine who show no or partial response to oral therapies, adjuvant approaches may be considered.…”

Section: An Updated Paradigm For the Treatment Of Dry Eye Based On Damentioning

confidence: 89%

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Baksh¹,

Garcia²

2021

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Section: An Updated Paradigm For the Treatment Of Dry Eye Based On Damentioning

confidence: 89%

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Baksh¹,

Garcia²

2021

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“…While many studies have examined treatment outcomes for nociceptive sources of ocular pain ( Dermer et al, 2020 ; Mittal et al, 2021 ), fewer have examined outcomes after treatment of neuropathic ocular pain. Furthermore, available literature typically report on the effects of one therapeutic modality in a limited number of patients ( Ozmen et al, 2020 ). To improve our fund of knowledge, this study examined clinical data from a cohort of individuals with a presumed neuropathic component to their chronic ocular surface pain, with the aim of studying subjective clinical responses to a number of commonly utilized medications.…”

Section: Introductionmentioning

confidence: 99%

Differential Effects of Treatment Strategies in Individuals With Chronic Ocular Surface Pain With a Neuropathic Component

et al. 2021

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Background: Dysfunction at the ocular system via nociceptive or neuropathic mechanisms can lead to chronic ocular pain. While many studies have reported on responses to treatment for nociceptive pain, fewer have focused on neuropathic ocular pain. This retrospective study assessed clinical responses to pain treatment modalities in individuals with neuropathic component ocular surface pain.Methods: 101 individuals seen at the University of Miami Oculofacial Pain Clinic from January 2015 to August 2021 with ≥3 months of clinically diagnosed neuropathic pain were included. Patients were subcategorized (postsurgical, post-traumatic, migraine-like, and laterality) and self-reported treatment outcomes were assessed (no change, mild, moderate, or marked improvement). One-way ANOVA (analysis of variance) was used to examine relationships between follow up time and number of treatments attempted with pain improvement, and multivariable logistic regression was used to assess which modalities led to pain improvement.Results: The mean age was 55 years, and most patients were female (64.4%) and non-Hispanic (68.3%). Migraine-like pain (40.6%) was most common, followed by postsurgical (26.7%), post-traumatic (16.8%) and unilateral pain (15.8%). The most common oral therapies were α2δ ligands (48.5%), the m common topical therapies were autologous serum tears (20.8%) and topical corticosteroids (19.8%), and the most common adjuvant was periocular nerve block (24.8%). Oral therapies reduced pain in post-traumatic (81.2%), migraine-like (73%), and unilateral (72.7%) patients, but only in a minority of postsurgical (38.5%) patients. Similarly, topicals improved pain in post-traumatic (66.7%), migraine-like (78.6%), and unilateral (70%) compared to postsurgical (43.7%) patients. Non-oral/topical adjuvants reduced pain in postsurgical (54.5%), post-traumatic (71.4%), and migraine-like patients (73.3%) only. Multivariable analyses indicated migraine-like pain improved with concomitant oral α2δ ligands and adjuvant therapies, while postsurgical pain improved with topical anti-inflammatories. Those with no improvement in pain had a shorter mean follow-up (266.25 ± 262.56 days) than those with mild (396.65 ± 283.44), moderate (652 ± 413.92), or marked improvement (837.93 ± 709.35) (p < 0.005). Identical patterns were noted for number of attempted medications.Conclusion: Patients with migraine-like pain frequently experienced pain improvement, while postsurgical patients had the lowest response rates. Patients with a longer follow-up and who tried more therapies experienced more significant relief, suggesting multiple trials were necessary for pain reduction.

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“…Pharmacological studies have shown that nortriptyline and desipramine have several other molecular targets that enhance its antinociceptive capabilities. Such targets include blockade of voltage‐gated sodium ion channels and specifically Na v 1.7 [28], sympathetic blockade, antagonism of N‐methyl‐D‐aspartate (NMDA) glutamate receptors, and anticholinergic effects [17, 24]. Unfortunately, interaction at various levels with different targets may also result in undesirable effects.…”

Section: Discussionmentioning

confidence: 99%

Antinociceptive effects of nortriptyline and desipramine hydrochloride in Speke's hinge‐back tortoise (Kinixys Spekii)

Makau

Towett

Kanui

et al. 2023

Fundamemntal Clinical Pharma

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Some of the most commonly used analgesic drugs in animals are of questionable efficacy or present adverse side effects among the various species of reptiles. Tricyclic antidepressants have been demonstrated to have antinociceptive effects in several animal models of pain and could be a good alternative for use in reptiles. The aim of the study was to investigate the antinociceptive effects of nortriptyline and desipramine hydrochloride in Speke's hinge-back tortoise. A total of 24 animals weighing 600-1000 g were used for nociceptive tests, i.e., formalin, capsaicin, and hot plate tests. Drugs were administered intracoelomically 30 min before starting the tests. The time spent in nocifensive behavior and the associated observable effects during the tests were recorded. Only the highest dose of 40 mg/kg of nortriptyline hydrochloride caused statistically significant decrease in nocifensive behavior in both the formalin and the capsaicin test. Desipramine hydrochloride at doses of 20 and 40 mg/kg caused statistically significant decrease in nocifensive behavior in the formalin test. Also, desipramine hydrochloride at doses of 15, 20, and 60 mg/kg caused statistically significant decrease in nocifensive behavior in the capsaicin test. None of the doses used for both drugs had any statistically significant effect on nocifensive behavior in the hot plate test. The results show that nortriptyline and desipramine hydrochloride have significant antinociceptive effects in the chemical but not thermal inflammatory pain-related behavior in the Speke's hinge-back tortoise. The most common associated side effect following administration of the higher doses of either of the drugs is excessive salivation. K E Y W O R D S antinociception, capsaicin test, desipramine hydrochloride, formalin test, nortriptyline hydrochloride, tortoise 1 | INTRODUCTION Reptile analgesia is a developing field in reptile medicine. It's generally agreed that analgesia should be an

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Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain

Cited by 21 publications

References 45 publications

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Differential Effects of Treatment Strategies in Individuals With Chronic Ocular Surface Pain With a Neuropathic Component

Antinociceptive effects of nortriptyline and desipramine hydrochloride in Speke's hinge‐back tortoise (Kinixys Spekii)

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