Tricyclic Antidepressants for Peripheral Neuropathy

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Abstract
To the Editor.— In their article "Medical Management of Chronic Cancer Pain," Shimm et al (241:2408, 1979) speculate that the tricyclic antidepressant drugs imipramine hydrochloride and amitriptyline hydrochloride may be helpful for chronic pain because of causing direct analgesic effects, potentiating other drugs, or simply by relieving depression. We are confident that tricyclic compounds are helpful for pain and paresthesias caused by peripheral neuropathy. Although a controlled study is still in formulation, we believe that amitriptyline has been particularly helpful for patients with diabetic neuropathy. Perhaps a fourth mechanism for effects of tricyclics in treating chronic pain or neuropathy consists of affecting neuronal or axonal transmission. Such a mechanism might especially be important for pain from cancer, which may cause a painful neuropathy, and from other causes of peripheral neuropathy, like diabetes.

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