NEW ORLEANS – Antidepressants and antiepileptics are both effective in treating neuropathic pain, but a combination performs best, according to Dr. Damon Robinson.
Dr. Robinson and colleagues found that nearly 80% of patients who took a combination of antiepileptics and antidepressant medications had a greater than 50% visual analogue scale (VAS) improvement, a statistically significant finding. The results were presented as a poster at the annual meeting of the American Academy of Pain Medicine.
Whereas clinical trials have shown clear evidence in favor of using antidepressants and antiepileptic medications alone in treating chronic pain, no studies have been designed to focus on the effect of combining antidepressants and antiepileptics for the treatment of neuropathic pain, wrote Dr. Robinson of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and his colleagues.
Over a 2-year period, the researchers reviewed 6,129 charts with an initial encounter and a diagnosis of neuropathic pain. They also analyzed VAS, medical procedures, and antidepressant and antiepileptic use and dosage at each visit. Patients who had a 50% or greater improvement in their VAS score were considered to have a favorable response.
Of the charts reviewed, 3,370 patients had at least one antidepressant or antiepileptic prescribed. All of the antidepressant and antiepileptic drugs analyzed had favorable responses in more than 70% of patients. There was a statistically significant level of improvement among patients prescribed tertiary amines and among those prescribed a combination of antiepileptics and antidepressants. A total of 939 patients received the combination, with 79.4% reporting a VAS score improvement of 50% or greater. About 19.4% of patients who received combination therapy had no response, and 1.2% had an unknown response.
While retrospective studies have limits, the results are encouraging and indicate the need for prospective studies, Dr. Robinson said in an interview.
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