Nortriptyline for neuropathic pain in adults

Area of Science:

• Neurology
• Pharmacology

Background:

• Antidepressants are commonly used for neuropathic pain at sub-antidepressant doses.
• Nortriptyline, a tricyclic antidepressant, is occasionally used for neuropathic pain and is recommended in several guidelines.

Purpose of the Study:

• To evaluate the pain-relieving effectiveness of nortriptyline.
• To assess adverse events associated with nortriptyline use in adults with chronic neuropathic pain.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, EMBASE) up to January 2015.
• Included randomized, double-blind studies of at least two weeks' duration comparing nortriptyline with placebo or other treatments.
• Assessed study quality and evidence tiers, focusing on pain reduction and adverse events.

Main Results:

• Six studies with 310 participants were included; all had potential for major bias.
• No high-quality evidence (first or second tier) supported nortriptyline's efficacy for neuropathic pain.
• Third-tier evidence suggested similar efficacy to placebo and other active treatments, with more adverse events than placebo.

Conclusions:

• Limited evidence supports nortriptyline for neuropathic pain due to methodologically flawed studies.
• Nortriptyline is not recommended as a first-line treatment for neuropathic pain.
• More effective treatments with stronger evidence, like duloxetine and pregabalin, are available.