(particularly amitriptyline), but some patients cannot tolerate their sedating and anticholinergic effects. The secondary amines are better tolerated than the tertiary amines, and adverse effects are less associated with these drugs.

TCAs such as amitriptyline, nortript

Adjuvant Analgesics (co-analgesics)

Adjuvant analgesics are drugs that are used primarily for treating conditions other than pain, but may be analgesic or assist in decreasing patients' perception of pain in certain circumstances. Adjuvant analgesics may be used alone or in combination with an opioid or a nonopioid pain reliever to treat persistent pain conditions, particularly neuropathic pain. Effective adjuvants typically include tricyclic antidepressants, antiepileptic drugs, muscle relaxants.

Antidepressants

Analgesic effect of antidepressants occurs at lower doses and more quickly than antidepressant effects. Antidepressants may be considered multipurpose analgesics, appropriate for a trial in any persistent pain condition.

The tricyclic antidepressants (TCAs) have been well studied and are most likely to be effective. TCAs are classified as tertiary amines (amitriptyline, imipramine, doxepin, clomipramine) and secondary amines (nortriptyline, desipramine). The evidence of analgesic efficacy is more extensive for the tertiary amines (particularly amitriptyline), but some patients cannot tolerate their sedating and anticholinergic effects. The secondary amines are better tolerated than the tertiary amines, and adverse effects are less associated with these drugs.

TCAs such as amitriptyline, nortript

e used alone or in combination with an opioid or a nonopioid pain reliever to treat persistent pain conditions, particularly neuropathic pain. Effective adjuvants typically include tricyclic antidepressants, antiepileptic drugs, muscle relaxants.

Antidepressants

Analgesic effect of antidepressants occurs at lower doses and more quickly than antidepressant effects. Antidepressants may be considered multipurpose analgesics, appropriate for a trial in any persistent pain condition.

The tricyclic antidepressants (TCAs) have been well studied and are most likely to be effective. TCAs are classified as tertiary amines (amitriptyline, imipramine, doxepin, clomipramine) and secondary amines (nortriptyline, desipramine). The evidence of analgesic efficacy is more extensive for the tertiary amines (particularly amitriptyline), but some patients cannot tolerate their sedating and anticholinergic effects. The secondary amines are better tolerated than the tertiary amines, and adverse effects are less associated with these drugs.

TCAs such as amitriptyline, nortript

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Analgesic effect of antidepressants occurs at lower doses and more quickly than antidepressant effects. Antidepressants may be considered multipurpose analgesics, appropriate for a trial in any persistent pain condition.

The tricyclic antidepressants (TCAs) have been well studied and are most likely to be effective. TCAs are classified as tertiary amines (amitriptyline, imipramine, doxepin, clomipramine) and secondary amines (nortriptyline, desipramine). The evidence of analgesic efficacy is more extensive for the tertiary amines (particularly amitriptyline), but some patients cannot tolerate their sedating and anticholinergic effects. The secondary amines are better tolerated than the tertiary amines, and adverse effects are less associated with these drugs.

TCAs such as amitriptyline, nortript

have been well studied and are most likely to be effective. TCAs are classified as tertiary amines (amitriptyline, imipramine, doxepin, clomipramine) and secondary amines (nortriptyline, desipramine). The evidence of analgesic efficacy is more extensive for the tertiary amines (particularly amitriptyline), but some patients cannot tolerate their sedating and anticholinergic effects. The secondary amines are better tolerated than the tertiary amines, and adverse effects are less associated with these drugs.

TCAs such as amitriptyline, nortript

(particularly amitriptyline), but some patients cannot tolerate their sedating and anticholinergic effects. The secondary amines are better tolerated than the tertiary amines, and adverse effects are less associated with these drugs.

TCAs such as amitriptyline, nortriptyline and desipramine have demonstrated efficacy for migraine, diabetic peripheral neuropathy, post herpetic neuralgia (PHN), arthritis pain and post stroke pain.

Newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are less effective at relieving neuropathic pain than the TCAs, but have significantly less adverse effects. Of the newer antidepressants, the SNRIs appear to be more effective analgesics than the SSRIs. Paroxetine (Paxil) is the only SSRI that has some evidence for efficacy in treating chronic pain. Two SNRIs Venlafaxine (Effexor) and Duloxetine (Cymbalta) have been shown to be analgesic in several studies. Venlafaxine provides inconsistent effects while Duloxetine, the newest of the SNRIs is the first antidepressant to be approved by the US Food and Drug Administration (FDA) for the treatment of neuropathic pain, specifically pain associated with diabetic neuropathy.

Anticonvulsants (Anti-epileptic drugs)

Anticonvulsants are commonly used in the manag