The medication of the antidepressant treated low backache

Medications Of The Antidepressant
Whereas several antidepressant classes have been used successfully in the treatment of a variety of syndromes of the pain, Literature the more strongly supports possible analgesic effectiveness of tricyclics (drug of the antidepressant). Amitriptyline (a type of antidepressant) has been investigated like analgesia more than the other agents of the antidepressant and appears to be the most popular analgesia of the antidepressant of the clinical adjustment. The headaches of jaqueca, the pain neuropathic associated to diabetic neuropatía, and the neuralgia postherpetic has been to respond favorable to the administration of the antidepressant.

These agents also have been to alleviate to the pain associated to conditions musculoskeletal such as fibromyalgia, reumatoide arthritis, and osteoartritis. The antidepressants have been used successfully in the treatment of the pain the cancer. In the population of the cancer, when she is administered concurrently with an antidepressant, agents of opioid can be used in a reduced dose and with a diminished incidence of indirect effect.

The analgesic antidepressant capacities were felt once to be related to the lightening of the depression, that can often accompany persistent pain, but several antidepressants have been to reduce symptoms of the pain in the patients who did not experience the depression Co-mo'rbida. These agents now are created to have primary analgesic capacities, that are related more likely to their effects on monoamines in endogenous ways of the pain. The effectiveness of selective antidepressants of serotonin and norepinephrine would suggest them effects on the ways that imply anyone of these transmitters could contribute to the analgesia. Other suggested mechanisms of the analgesia imply the characteristics of the antihistamine one of certain agents, increasing secretion of endorphin, and an increasing density of the cortical channels of calcium.

In a study of 44 patients admitted for the low backache, Jenkins ET the a compared the treatment with imipramine oral (Tofranil®), 25-mg t.i.d. (three times per day), with placebo on a cuatrisemanal period. After the treatment, no significant difference in the improvement in raising rectum of the leg, the burdens of the pain and the stiffness, nor the psicologica test was observed between both training groups. In those individuals with evident pain discogenic, imipramine treated patients demonstrated to the greater improvement in pain and stiffness, but this one was not found to be statistical significant. Any significant difference in indirect effect between groups was not observed both.

In a study of 48 patients with backache under chronic, the treatment with imipramine was compared to placebo. Seven of the patients including were determined clinical pressed according to standard criteria. The patients finished questionnaires of the depression of the dye Cuba in the initial visits and of the end. The improvements of the account of the depression, whereas nonstatistical they are not significant, were observed in those patients who benefitted from the treatment of imipramine. The individuals dealt with imipramine demonstrated a significant improvement in both limitations of the work and the restrictions in normal activities. The indirect effect anticholinergic were associated to a tariff of the exit of 10%.

In a revision of Literature in antidepressants in the treatment of the backache under chronic, Egbunike ET the a concluded that the most constant answers were found with doxepin (Sinequan®) and desipramine in the daily doses on 150-mg. Some studies could not have been able to demonstrate a secondary answer to the inadequate metering. Other antidepressants were found less effective in the supplying of analgesia. In several reviewed studies, whereas the improvements in the depression were observed, the poor correlations were observed between the effects and the analgesic changes in the severity of the depression. The relation between the relevación of the pain and the effect the antidepressant continues being confused.

Metering
Tricyclic analgesia of the product of antidepressants (TCAs) in meterings lower than is prescribed typically for the treatment of the depression. The dose that begins of tricyclics must be low. The initial daily metering of amitriptyline must be 10-mg in greater patients and 25-mg in younger individuals. Each two to three days an increase in the equal metering to the dose that begins initial can be done until the suitable analgesia is reached or the injurious effects become.

The typical effective daily dose of amitriptyline extends from the 50- to 150-mg, although the as low doses as 10-25-mg can be beneficial in some patients. Then the period of the TCA is generally long and the sedación is a common indirect effect, the single metering at night can be prescribed. Some patients in the morning disclose a better relevación of the pain and less somnolencia with the divided daily metering. Those studies, that have investigated the analgesic effectiveness of selective inhibitors of reuptake of serotonin (SSRIs), have implied typically the meterings similar to those prescribed in the management of the depression, 20- to 40-mg of fluoxetine or paroxetine. The additional investigation is necessary to clarify the relation between the metering and the analgesia with the agents of the specific one of serotonin.

Injurious Effects
The occurrence of the serious injurious effects that are from the administration of the antidepressant is low. These complications would be rare in the meterings generally more losses used in the treatment of the pain. Whereas the indirect effect cardiac are infrequent, tricyclics is contraindicated in those individuals with cardiac unemployment or serious abnormalitys cardiac of the conduction. The hypotension orthostatic is more frequent the cardiovascular injurious effect, and the old ones are particularly in the risk. The effect of sedación observed often with use of the antidepressant can be beneficial whereas the patients with pain often demonstrate the diminished day that she works of inadequate dream.

The indirect effect anticholinergic such as dry mouth, guarded vision, and urinary retention is more probable with use of amitriptyline that with the other TCAs. These effects are also less probable in the used lowest meterings for the analgesia. Nortriptyline and desipramine has been to induce few indirect effect anticholinergic and is giving a sedative less.

Whereas the antidepressants have been demonstrated like useful associates in the treatment of the pain, its analgesic mechanism continues being confused. The initial metering must low and later be increased slowly to reduce to the minimum indirect effect. When they are taken at night, the characteristics of sedación of these agents can be beneficial in those patients of the pain who experience difficulty with dream.

Reference:
Malanga GA, ET to. Treatment pharmacologic of the low backache. In revisions physical outposts of the medicine and the rehabilitation, Philadelphia, Hanley and Belfus Vol.13, No.3, October of 1999

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