Tricyclic Antidepressants in Post-SCI Pain

Q24.  What is the evidence for the use of tricyclic antidepressants for post-SCI pain?
1. There is level 1 evidence that amitriptyline is effective in the treatment of post-SCI pain in depressed individuals.
2. There is Level 1 evidence that trazodone does not reduce post-SCI neuropathic pain.
Tricyclic antidepressant drugs are thought to modulate pain by inhibiting the uptake of norepinephrine and serotonin in the CNS. Tricyclic antidepressants exert an analgesic effect by making more serotonin available in the CNS, thereby potentiating the inhibitory action of the dorsal horn of the spinal cord. Unfortunately, these medications are often sedating and produce a variety of anticholinergic side effects.

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