Use of Tricyclic antidepressants (TCA)’s for neuropathic pain was based on an article for diabetic neuropathy where, through frequent phoning and support, authors were able to get patients up to 150 mg. No one has succeeded in getting people up to these doses since and success with TCA has been less. Now, in the case of desipramine, Cochrane has come out and said it – “This review found little evidence to support the use of desipramine to treat neuropathic pain. There was very low quality evidence of benefit and harm, but this came from studies that were methodologically flawed and potentially subject to major bias. Effective medicines with much greater supportive evidence are available.”
I have written how Nortriptyline is of little use in Neuropathic pains:
Is Nortriptyline Any Good? – Maybe – but Maybe Only a Bit
http://painmuse.org/?p=3316
I wish speakers would stop extolling the virtues of TCA’s when their effects are poor at best. – use better drugs.
1. Cochrane Database Syst Rev. 2014 Sep 23;9:CD011003. [Epub ahead of print]
Desipramine for neuropathic pain in adults.
Hearn L(1), Moore RA, Derry S, Wiffen PJ, Phillips T.
http://www.ncbi.nlm.nih.gov/pubmed/25246131
Comment – One recent evaluation found only 1/4 of chronic pain cases came under adequate control with medications including opioids. That means doing other measures – many I have tried to include in this blog.