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23rd Annual Meeting
February 7-10, 2007
New Orleans, LA
© 2006 American Academy of Pain Medicine
 


Thursday, February 8, 2007
160

Evaluation of the Prescribing Patterns and Efficacy of Antidepressant and Antiepileptic Medications for the Treatment of Neuropathic Pain in a Multidisciplinary Pain Center

Damon Robinson, MD, Zahid Bajwa, MD, Jan Kraemer, MD, Andy Linn, MD, John Bernardini, MD, and Sarah Nabel. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Hypothesis: It has been demonstrated that antidepressant and antiepileptic medications are efficacious in the treatment of neuropathic pain (3). We hypothesize that patients with neuropathic pain taking antidepressant and/or antiepileptic medication have more favorable treatment responses than patients who are not taking either or these medication.

Design: Retrospective chart review.

Setting: Outpatient multidisciplinary pain clinic.

Participants: 6,129 patients with neuropathic pain.

Main Outcome Measure: Physician rated visual analog scale (VAS) of response to medications.

Method: Filtered through 31,239 visits from January 2004 through December 2005. Reviewed all charts with an initial encounter and a diagnosis of neuropathic pain (6129). Analyzed the VAS score, procedure, antidepressant, antiepileptic and dose of each visit. Patients with a 50% or greater improvement in VAS score were deemed to have favorable responses.

Results: Of the 6129 charts reviewed, 3370(55.4%) recorded the prescription of at least one antidepressant or antiepileptic. Of the 501 patients receiving secondary amines, favorable responses were recorded for 375(75%) patients, while 125(25%) did not respond and 7 had unknown responses. Of the 575 patients receiving tertiary amines, favorable responses were recorded for 442(77%) patients, while 132(23%) did not respond and 4 had unknown responses. Of the 633 patients receiving SSRIs, favorable responses were recorded for 449(71%) patients, while 183(29%) did not respond and 4 had unknown responses. Of the 412 patients receiving atypicals, favorable responses were recorded for 304(74%) patients, while 107 (26%) did not respond and 3 had unknown responses. Of the 1230 patients receiving antiepileptic, favorable responses were recorded for 910(74%) patients, while 246(20%) did not respond and 12 had unknown responses

Conclusions: The data supports our clinical impression that antidepressants and antiepileptics are effective among patients with neuropathic pain. The combination of antidepressant and antiepileptic medication proved to be superior to either medication used alone.


References: 1) Backonja, M, Glanzman, RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther 2003; 25:81.

2)Danish University Antidepressant Group. Paroxetine: a selective serotonin reuptake inhibitor showing better tolerance, but weaker antidepressant effect than clomipramine in a controlled multicenter study. J. Affect. Dis. 1990;18:289-99.

3)Woolf, CJ, Mannion, RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353:1959.
Funding: None

Damon Robinson, MD
Nothing to disclose.

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