Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial.
Amitriptyline (AT) relieves some patients with postherpetic neuralgia (PHN). Many patients suffer side effects and better therapies are necessary. The aim of this study was to evaluate the efficacy of maprotiline (MT) (noradrenergic) compared to AT (mixed noradrenergic and serotonergic) in this disorder. Thirty-five patients entered a randomized, double-blind, crossover trial of these two agents. We found that MT relieved PHN in many patients but was not as effective as AT. Side effects were troublesome with both agents. Relief of steady pain, brief pain and pain on tactile stimulation occurred. Four groups of responses were identified. Some patients reported relief with both agents, some with neither agent and others with only one of the drugs. Most patients were not depressed and analgesia was observed to occur without change in depression ratings in most patients who responded. This result provides evidence that in some patients AT may act via a selective noradrenergic mechanism in relieving PHN and that individuals may differ in the balance and type of neurotransmitters inhibiting pain. Selective noradrenergic agents may be effective if AT fails.
Watson
Peter N C
PNC
The Irene Eleanor Smythe Pain Clinic, University of Toronto, Toronto, Ont.Canada Clinical Research Support Unit, Unirersity of Toronto, Toronto, Ont.Canada Queen Street Mental Health Center, Toronto, Ont., Canada Epidemiology and Community Medicine, Unirersity of Ottawa, Ottawa, Ont.Canada.
Chipman
Mary
M
Reed
Ken
K
Evans
Ramon J
RJ
Birkett
Nicholas
N
D000368:Aged; D000369:Aged, 80 and over; D000639:Amitriptyline / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006562:Herpes Zoster / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008376:Maprotiline / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D012890:Sleep / Q000187:drug effects
D000639:Amitriptyline; D008376:Maprotiline