Table 3

ADs in pain conditions 1
Condition AD treatment, role in strategy, rating of the recommendation Comments and role of other treatments
Neuralgia and painful polyneuropathy[22-26] ADs recommended: -Similar statements between guidelines:
-TCAs: Amitriptyline first line (25–150 mg/day, Level A) Nortriptyline (alternative option) [22-26] NNT of 3.6 (95% CI: 3-4.5). -Strong consensus for TCAs and venlafaxine.
-SNRIs: Venlafaxine, fist line treatment (Level A) NNT of 3.1 Duloxetine: option -Gabapentin, Pregabalin: also recommended as first-line treatments. TCAs are equally effective compared to non-AD drugs gabapentin (1200–3600 mg/day) and pregabalin (150–600 mg/day)
SSRI: not recommended
Painful Diabetic Neuropathy (PDN)[25-29] ADs recommended:
-Duloxetine 60 mg and 120 mg daily, first-line, (Level A) The NNT for effectiveness was 1.3 (95% CI: 1.2- 1.5). This AD has on-label use for this condition [25,26,28] Duloxetine: conflicting evidence between guidelines, just cited as a therapy for NP in the EFNS GL[24], and only for PDN in the Cochrane Review
-Venlafaxine 150–225 mg/day; first line (no level mentioned)TCA : If other ADs contraindicated, Amitriptyline is an option Venlafaxine might be added to gabapentin for a better response (Level C).
SSRIs: not recommended
HIV-related neuropathies[27] No AD treatment recommended -Evidence not to prescribe any AD
- Recommended non-AD treatments: -lamotrigine (Level B), smoking cannabis (Level A), capsaicin patches (Level A)
Phantom limb pain[30] No AD treatment recommended Amitriptyline was not different from placebo
Trigeminal neuralgia[25,26] -ADs are not first-line treatment -Similar statements but lack of comparative trials to assess a precise role for TCAs and venlafaxine.
-ADs recommended: TCA or venlafaxine are alternative treatments First-line: carbamazepine (Level A) and oxcarbazepine (Level B)
Postherpetic neuralgia[25,26] -ADs are not first-line treatments -Similar statements but lack of comparative trials to assess a precise role for TCAs and venlafaxine
- ADs recommended: TCA or venlafaxine are alternative treatments -First-line: gabapentin / pregabalin (Level A)
Central pain 2[24] -ADs are not first-line treatment -Similar statements between guidelines
- ADs recommended: TCAs: Amitriptyline second-line (Level B)- SNRIs: Duloxetine and venlafaxine second choice (Level B) -Pregabalin: first-line (level A)
Migraine and tension type headaches[31-34] ADs recommended: -Similar statements for TCAs, and SSRIs. Disagreement for the usefulness of venlafaxine
-TCA: Amitryptiline 25-150 mg per day, (Level A).-Venlafaxine 75-150 mg was presented as an effective alternative to tricyclic antidepressants (Level B) -TCA: In cases of TTH with associated drug abuse, the role of this treatment was only mentioned, with no rating, by the French HAS.
SSRIs: not recommended
Sciatica, non-specific low back pain[35-37] No AD treatments recommended Only to be prescribed as an option in the event of associated depression (NICE)
Very weak evidence for TCAs observed by the French HAS (level C)
Fibromyalgia3[28,38] ADs recommended: Alternative pharmacological options: Gabapentin, tramadol
SNRIs: Milnacipran 12.5 mg once daily, target dose of 50-100 mg two times per day
-Duloxetine: 60 mg twice daily, -Venlafaxine could be prescribed -TCAs showed evidence
SSRIs: not recommended
Burning mouth syndrome[39] No AD treatments recommended -Two RCTs showed no antidepressant effects

(1) Neuropathic pain is related to different treatment strategies and different conditions detailed in this table.

(2) Diffuse pain, refractory or recurrent pain, central pain, pain connected with multiple sclerosis, dysesthesia after stroke or paraplegia.

(3) See also comments in plain text: General or non-specific conditions and general symptoms.

Mercier et al.

Mercier et al. BMC Family Practice 2013 14:55   doi:10.1186/1471-2296-14-55

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