Tricyclics for chronic pain syndromes

Tricyclic antidepressants can be used for in the management of a range of chronic pain syndromes, including:

• neuropathic pain:
  • post-herpetic neuralgia
  • diabetic neuropathy
• post-stroke pain
• irritable bowel syndrome
• temporomandibular joint dysfunction
• atypical facial pain
• fibromyalgia
• migraine

In many of these conditions 50-90% of patients can be expected to achieve a 50% or greater reduction in pain. The number of patients needed to be treated in order to achieve a 50% reduction in pain in an individual patient are:

• 3.0 in diabetic neuropathy
• 2.8 in atypical facial pain
• 1.7 in post-stroke pain

The trial evidence is generally for low dose amitriptyline. Other antidepressants may be effective.

For full guidance then see linked item regarding NICE guidance below. Consult the respect Summary of Product Characteristic (SPC) of any medication mentioned before prescribing.