Opioids versus antidepressants in postherpetic neuralgia: A randomized, placebo-controlled trial

Srinivasa Naga Raja, Jennifer Haythornthwaite, M. Pappagallo, Michael Clark, T. G. Travison, S. Sabeen, R. M. Royall, M. B. Max

Research output: Contribution to journalArticle

Abstract

Background: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. Objective: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. Methods: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100%), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. Results: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p <0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32%) compared with placebo (11%; p <0.001). More patients completing all three treatments preferred opioids (54%) than TCA (30%; p = 0.02). Conclusions: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect.

Original languageEnglish (US)
Pages (from-to)1015-1021
Number of pages7
JournalNeurology
Volume59
Issue number7
StatePublished - Oct 8 2002

Fingerprint

Postherpetic Neuralgia
Tricyclic Antidepressive Agents
Opioid Analgesics
Antidepressive Agents
Randomized Controlled Trials
Placebos
Pain
Cognition
Nortriptyline
Desipramine
Methadone
Therapeutics
Cross-Over Studies
Morphine
Analgesics
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Opioids versus antidepressants in postherpetic neuralgia : A randomized, placebo-controlled trial. / Raja, Srinivasa Naga; Haythornthwaite, Jennifer; Pappagallo, M.; Clark, Michael; Travison, T. G.; Sabeen, S.; Royall, R. M.; Max, M. B.

In: Neurology, Vol. 59, No. 7, 08.10.2002, p. 1015-1021.

Research output: Contribution to journalArticle

Raja, SN, Haythornthwaite, J, Pappagallo, M, Clark, M, Travison, TG, Sabeen, S, Royall, RM & Max, MB 2002, 'Opioids versus antidepressants in postherpetic neuralgia: A randomized, placebo-controlled trial', Neurology, vol. 59, no. 7, pp. 1015-1021.
Raja, Srinivasa Naga ; Haythornthwaite, Jennifer ; Pappagallo, M. ; Clark, Michael ; Travison, T. G. ; Sabeen, S. ; Royall, R. M. ; Max, M. B. / Opioids versus antidepressants in postherpetic neuralgia : A randomized, placebo-controlled trial. In: Neurology. 2002 ; Vol. 59, No. 7. pp. 1015-1021.
@article{c0412462c7da412d886817ad8769b2a9,
title = "Opioids versus antidepressants in postherpetic neuralgia: A randomized, placebo-controlled trial",
abstract = "Background: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. Objective: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. Methods: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100{\%}), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. Results: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p <0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32{\%}) compared with placebo (11{\%}; p <0.001). More patients completing all three treatments preferred opioids (54{\%}) than TCA (30{\%}; p = 0.02). Conclusions: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect.",
author = "Raja, {Srinivasa Naga} and Jennifer Haythornthwaite and M. Pappagallo and Michael Clark and Travison, {T. G.} and S. Sabeen and Royall, {R. M.} and Max, {M. B.}",
year = "2002",
month = "10",
day = "8",
language = "English (US)",
volume = "59",
pages = "1015--1021",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Opioids versus antidepressants in postherpetic neuralgia

T2 - A randomized, placebo-controlled trial

AU - Raja, Srinivasa Naga

AU - Haythornthwaite, Jennifer

AU - Pappagallo, M.

AU - Clark, Michael

AU - Travison, T. G.

AU - Sabeen, S.

AU - Royall, R. M.

AU - Max, M. B.

PY - 2002/10/8

Y1 - 2002/10/8

N2 - Background: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. Objective: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. Methods: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100%), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. Results: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p <0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32%) compared with placebo (11%; p <0.001). More patients completing all three treatments preferred opioids (54%) than TCA (30%; p = 0.02). Conclusions: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect.

AB - Background: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. Objective: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. Methods: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100%), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. Results: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p <0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32%) compared with placebo (11%; p <0.001). More patients completing all three treatments preferred opioids (54%) than TCA (30%; p = 0.02). Conclusions: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect.

UR - http://www.scopus.com/inward/record.url?scp=0037044286&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037044286&partnerID=8YFLogxK

M3 - Article

C2 - 12370455

AN - SCOPUS:0037044286

VL - 59

SP - 1015

EP - 1021

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 7

ER -