[Reproducible efficacy of tricyclic antidepressant on chronic pain in an elderly patient with osteoporosis].
An 81-year-old woman was admitted due to exacerbation of chronic back pain from a vertebral osteoporosis fracture. The lumbar MRI examination revealed compression fracture of Th12 and L1 bones. Initial treatment with roxoprofen, calcitonin, bupurenorfin, and morphine did not achieve pain reduction in the patient. Because her geriatric depression scale score was low, we next tried to treat the pain using an antidepressant. Although the pain was improved by amitriptyline, the side effects of dry mouth and urinary incontinence were occurred. Milnacipran, a serotonin and norepinephrine reuptake inhibitor (SNRI), was then tried for the treatment of the chronic pain instead of amitriptyline, but the pain was increased. Then, she was given amitriptyline again for treatment of the chronic back pain instead of SNRI. The second-time amitriptyline treatment was effective to reduce the pain, with minimal side-effects. Because chronic pain due to osteoporosis is often difficult to treat in elderly patients, the classic antidepressant, amitriptyline, may help pain control by narcotics and anti-inflammatory agents in some elderly patients.
Hibi
Shinichiro
S
Department of Geriatric Medicine, Division of Aging Science, Graduate School of Medicine, The Tokyo University.
Yamaguchi
Yasuhiro
Y
Teramoto
Shinji
S
Yamamoto
Hiroshi
H
Eto
Masato
M
Akishita
Masahiro
M
Ouchi
Yasuyoshi
Y
D000369:Aged, 80 and over; D000639:Amitriptyline / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy* / Q000209:etiology; D002908:Chronic Disease; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D015663:Osteoporosis, Postmenopausal / Q000150:complications*
D018712:Analgesics, Non-Narcotic; D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline