WESTPORT, CT (Reuters Health) Dec 15 - Antidepressants and anticonvulsants provide similar analgesia with similar levels of minor side effects in patients with diabetic neuropathy or postherpetic neuralgia, according to a study published in the December issue of the Journal of Pain and Symptom Management.
Dr. Henry J. McQuay, of the University of Oxford, UK, and colleagues reviewed the medical literature for studies that compared antidepressants or anticonvulsants with placebo in the management of pain in patients with diabetic neuropathy or postherpetic neuralgia.
"Both antidepressants and anticonvulsants clearly have an analgesic effect when compared with placebo for both diabetic neuropathy and postherpetic neuralgia," the investigators write. Specifically, for every three patients treated with one of the two drugs, one experienced a 50% improvement in pain that would not have been experienced with placebo.
On subgroup analysis, serotonin-reuptake inhibitors did not appear to be as effective as tricyclic antidepressants, while gabapentin was as effective as older anticonvulsants.
The two drug classes were also associated with similar rates of minor adverse effects. In general, for every three patients who took one of the drugs, one experienced a minor adverse effect that would not have been experienced with placebo.
However, the risk of serious adverse effects resulting in treatment withdrawal was higher in studies of antidepressants than in studies of anticonvulsants. For antidepressants, one in every 17 patients treated experienced such a side effect. For anticonvulsants, the risk of a serious side effect was no greater in patients who were treated than in controls in the studies examined.
The findings offer little help in defining "a first-line drug of choice for neuropathic pain," Dr. McQuay and colleagues conclude.
J Pain Symptom Manage
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