Posted by kaleidoscope on November 18, 2007, at 15:13:04
In reply to Degenerative Disc Disease and Psychiatric Meds, posted by Philip Burke on November 17, 2007, at 16:39:33
Hi
It's interesting that you're taking Remeron and Zoloft since neither of these drugs are generally used to treat neuropathic pain. SSRIs such as Zoloft are considered to be ineffective in the treatment of neuropathic pain whereas Remeron has not been studied for this indication. It is important to bear in mind that although some antidepressants have a clear role in the treatment of neuropathic pain (eg. amitriptyline), others show no efficacy at all.
The tricyclic antidepressants are often the most effective drug treatment for neuropathic pain. Amitriptyline (Elavil) is the best established. The usual initial dose is 10 or 25mg at night increasing to 50-75mg. Nortriptyline can be used as an alternative - starting with 10mg at night and increasing up to a usual maximum of 75mg. Nortriptyline is considerably less sedating than amitriptyline and causes a lower incidence of adverse effects overall. Other tricyclic antidepressants such as imipramine and desipramine are also sometimes used to treat neuropathic pain. Desipramine is much less sedating than amitripyline.
SSRIs show very little efficacy in the treatment of neuropathic pain and should not generally be prescribed solely for this purpose.
Among the newer antidepressants, venlafaxine (Effexor) and duloxetine (Cymbalta) can be effective in the treatment of neuropathic pain, most notably diabetic neuropathy. Duloxetine (Cymbalta) is officially approved for diabetic neuropathic pain. The usual dose is 60mg per day. Effexor and Cymbalta both cause a high incidence of side effects and are much more expensive than tricyclics.
Among the antiepileptics, gabapentin (Neurontin) and pregabalin (Lyrica) are similar in effectiveness and have received the most study. Carbamazepine (Tegretol) may also be effective, although it is not as well proven. If necessary, the dose of pregabalin can be increased up to a maximum of 600mg per day in two or three divided doses. Side effects are dose-dependent.
Tramadol, a weak opioid with additional properties, has shown effectiveness in the treatment of certain types of neuropathic pain. Tramadol can be tried before considering potent opioids.
poster:kaleidoscope
thread:795592
URL: http://www.dr-bob.org/babble/20071115/msgs/795779.html