Justin P Reinert, Michael A Veronin, Christopher Medina
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引用次数: 1
Abstract
Objectives: To determine the efficacy and safety of commonly prescribed tricyclic antidepressants (TCAs) as analgesics for nociceptive and neuropathic pain in combination with opioids. Data Sources: A comprehensive literature review was conducted with the assistance of a medical reference librarian on PubMed, MEDLINE, Scopus, and Web of Science using the following search terminology: "Amitriptyline" OR "Doxepin" OR "Desipramine" OR "Imipramine" OR "Nortriptyline" OR "Clomipramine" OR "Trimipramine" AND "Analgesia." Reports of adult patients who received any TCA as an adjunctive analgesic to opioids were included. Study Selection and Data Extraction: A total of 293 results were obtained from the initial database inquiries, following which exclusion criteria were applied and 6 articles were included in this review. Three of the reports detailed the use of TCAs in the perioperative setting, whereas the remaining 3 evaluated their effect on different etiologies of neuropathic pain. Data Synthesis: Tricyclic antidepressants were found to have modest, yet not insignificant, independent analgesic properties, although the ability to provide pain relief was relegated to a select few agents. Desipramine has the most data available for use in nociceptive, postoperative pain through its ability to potentiate and prolong the analgesic effects of opioids and was not associated with adverse drug effects. Conclusions: The efficacy of TCAs for neuropathic pain was not corroborated by this review, and the anticholinergic adverse effects associated with this drug class were found to be significant. Further research is needed to quantify the efficacy of TCAs in the management of nociceptive pain.
目的:探讨常用三环抗抑郁药(TCAs)与阿片类药物联用治疗痛觉性和神经性疼痛的疗效和安全性。数据来源:在PubMed、MEDLINE、Scopus和Web of Science的医学参考馆员的协助下,使用以下搜索术语进行了全面的文献综述:“阿米替林”或“多肽平”或“地西帕明”或“丙咪帕明”或“去甲替林”或“氯丙帕明”或“三甲帕明”和“镇痛”。包括接受任何TCA作为阿片类药物辅助镇痛药的成年患者的报告。研究选择和数据提取:从最初的数据库查询中获得293个结果,然后应用排除标准,6篇文章被纳入本综述。其中3份报告详细介绍了tca在围手术期的应用,而其余3份报告则评估了它们对不同病因神经性疼痛的影响。数据综合:发现三环抗抑郁药具有适度但并非微不足道的独立镇痛特性,尽管提供疼痛缓解的能力被降级为少数药物。地西帕明可增强和延长阿片类药物的镇痛作用,且与药物不良反应无关,因此在伤害性和术后疼痛中使用地西帕明的数据最多。结论:本综述未证实TCAs治疗神经性疼痛的疗效,且发现该类药物的抗胆碱能不良反应显著。需要进一步的研究来量化tca在治疗伤害性疼痛方面的疗效。
期刊介绍:
For both pharmacists and technicians, jPT provides valuable information for those interested in the entire body of pharmacy practice. jPT covers new drugs, products, and equipment; therapeutic trends; organizational, legal, and educational activities; drug distribution and administration; and includes continuing education articles.