ORIGINAL

425

R e v. Soc. Esp. Dolor 7: 425-430, 2000

Tratamiento del dolor neuropático: estudio preliminar de amitriptilina frente a nefazodona L. Cánovas*, J. Martínez-Salgado*, C. Barros**, A. Gómez-Pombo*, M. Castr o - B a n d e * * y A. Castro - M é n d e z * * *

Results:

Cánovas L, Martínez-Salgado J, Barros C, GómezPombo A, Castro-Bande M and Castro-Méndez A. Management of neuropathic pain: preliminary study of amitriptiline versus nefazodone. Rev Soc Esp Dolor 2000; 7: 425-430.

SUMMARY Objective: To assess the analgesic effectiveness and tolerance of amitriptiline versus nefazodone for the management of n e u ropathic pain. Material and methods: We perf o rmed a prospective study in 120 patients over a 18-month period. All the patients had neuropathic pain with 1-6 months of evolution. The quality of pain was burning and cutting in 62.3% of the cases, lancinating in 40% and sharp in 25%. The patients were divided into two g roups: A, received amitriptiline with doses of 25 mg/day and weekly increments of 25 mg, until a maximum of 150 mg; B, received nefazodone with doses of 50 mg/day and weekly increments of 50 mg until a maximum of 300 mg. In 48 patients, a simultaneous treatment was initiated with anticonvulsants due to the presence of a component of paroxismal lancinating pain, those patients being assessed separately. Pain and adverse effects were assessed at the t h i rd week of therapy, as well as at one and three months, t h rough a visual analogic scale (VA S ) .

The most frequent painful syndromes were: neuro p a t h i c pain associated to cancer and postherpetic neuralgia (n=16), diabetic polineuropathy, lumbar pain and trigeminal neuralgia (n=14), painful phantom limb, complex regional pain syndrome type I, and postsurgical neuralgia (n =10), fibromialgia and Arnold´s neuralgia (n=5) and thalamic pain (n=4). Average doses of amitriptiline and nefazodone were 75 ± 52 mg and 240 ± 64 mg. Global severity of pain, measured through VAS, was 8,7 ± 1.2 for the amitriptiline group and 8.5 ± 0.9 for the nefazodone group. After three months of therapy, the amitriptiline group showed a pain severity of 2 ± 0.9 and the nefazodone group, 3 ± 1.1. Pain relief was over 75% (excellent) in 42 patients treated with amitriptiline and in 36 patients treated with nefazodone, between 50-75% (good) in 18 patients treated with amitriptiline and in 12 patients t reated with nefazodone, and bellow 50% (Poor) in 3 patients treated with amitriptiline and 3 patients treated with nefazodone. Side effects were most common with amitriptiline compared to nefazodolone. (p