Selected tricyclic antidepressants in the management of chronic benign pain

Depression is often considered a symptom of intractable benign pain and is usually a situational or exogenous subtype. At our four hospital-based pain management centers we have evaluated and treated more than 5,000 patients for chronic pain. The treatment of more than 2,000 of these patients has included the administration of doxepin or amitriptyline. This article reviews the therapeutic use of selected tricyclic antidepressants in the treatment of chronic benign pain and depression, and emphasizes the blockage of serotonin reuptake as the mechanism of action. The benefits of doxepin and amitriptyline include sleep facilitation, low cardiotoxicity and incidence of anticholinergic effects, and anxiolytic properties.