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Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial
Peter N C Watson1, Mary Chipman, Ken Reed
1The 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.
Pain
|January 1, 1992
Summary
Maprotiline (MT) and amitriptyline (AT) both treat postherpetic neuralgia (PHN) pain, but AT was more effective. Both medications caused side effects, indicating a need for improved PHN therapies.
Area of Science:
- Neurology
- Pharmacology
- Pain Management
Background:
- Postherpetic neuralgia (PHN) is a neuropathic pain condition often treated with amitriptyline (AT).
- Many patients experience significant side effects with AT, necessitating the exploration of alternative therapies.
- Understanding the neurochemical mechanisms of analgesia in PHN is crucial for developing better treatments.
Purpose of the Study:
- To compare the efficacy of maprotiline (MT), a noradrenergic agent, with amitriptyline (AT), a mixed noradrenergic and serotonergic agent, in treating PHN.
- To investigate the different patient response patterns to these two medications.
- To explore the relationship between pain relief and depression in PHN patients.
Main Methods:
- A randomized, double-blind, crossover trial involving 35 patients with PHN.
- Patients received both maprotiline (MT) and amitriptyline (AT) for comparison.
- Data collected on pain relief (steady, brief, tactile) and side effects.
Main Results:
- Maprotiline (MT) provided some relief for PHN, but was less effective than amitriptyline (AT).
- Both MT and AT caused troublesome side effects in patients.
- Four distinct patient response groups were identified: those responding to both, neither, or only one of the drugs.
- Analgesia occurred in most responders without significant changes in depression ratings.
Conclusions:
- Amitriptyline (AT) appears more effective than maprotiline (MT) for PHN pain relief.
- Individual differences in neurotransmitter pathways may influence treatment response in PHN.
- Selective noradrenergic agents could be a viable option for patients who do not respond to AT.