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. 1990 Sep-Oct;37(5):223–229.

Utilization and mechanism of action of tricyclic antidepressants in the treatment of chronic facial pain: a review of the literature.

R S Brown 1, W K Bottomley 1
PMCID: PMC2148604  PMID: 2096745

Abstract

Tricyclic antidepressants show promise in the treatment of chronic facial pain. The antinociceptive activity of this class of drugs appears to be independent of any antidepressant effects. An hypothesis is proposed that tricyclics antidepressants activate a descending serotonergic (5-HT1) antinociceptive pathway which in turn influences endogenous opioids. This antinociceptive pathway appears to utilize an endogenous pain modulation system. Future studies may demonstrate the operative mechanisms of action and open understanding as to etiologic factors.

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Selected References

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  1. Bjørkum A. A., Berge O. G. The relative contribution of ascending and descending serotonergic pathways in p-chloroamphetamine-induced antinociception. Pharmacol Biochem Behav. 1988 Sep;31(1):135–140. doi: 10.1016/0091-3057(88)90324-3. [DOI] [PubMed] [Google Scholar]
  2. Bottomley W. K., Brown R. S., Lavigne G. J. A retrospective survey of the oral conditions of 981 patients referred to an oral medicine private practice. J Am Dent Assoc. 1990 May;120(5):529–533. doi: 10.14219/jada.archive.1990.0080. [DOI] [PubMed] [Google Scholar]
  3. Bourson A., Moser P. C., Gower A. J., Mir A. K. Central and peripheral effects of the dihydropyridine calcium channel activator BAY K 8644 in the rat. Eur J Pharmacol. 1989 Feb 7;160(3):339–347. doi: 10.1016/0014-2999(89)90089-7. [DOI] [PubMed] [Google Scholar]
  4. Charney D. S., Heninger G. R., Sternberg D. E. Serotonin function and mechanism of action of antidepressant treatment. Effects of amitriptyline and desipramine. Arch Gen Psychiatry. 1984 Apr;41(4):359–365. doi: 10.1001/archpsyc.1984.01790150049008. [DOI] [PubMed] [Google Scholar]
  5. Davis J. L., Lewis S. B., Gerich J. E., Kaplan R. A., Schultz T. A., Wallin J. D. Peripheral diabetic neuropathy treated with amitriptyline and fluphenazine. JAMA. 1977 Nov 21;238(21):2291–2292. [PubMed] [Google Scholar]
  6. De Felipe M. C., De Ceballos M. L., Gil C., Fuentes J. A. Chronic antidepressant treatment increases enkephalin levels in n. accumbens and striatum of the rat. Eur J Pharmacol. 1985 May 28;112(1):119–122. doi: 10.1016/0014-2999(85)90247-x. [DOI] [PubMed] [Google Scholar]
  7. Diamond S., Baltes B. J. Chronic tension headache--treated with amitriptyline--a double-blind study. Headache. 1971 Oct;11(3):110–116. doi: 10.1111/j.1526-4610.1971.hed1103110.x. [DOI] [PubMed] [Google Scholar]
  8. Eberhard G., von Knorring L., Nilsson H. L., Sundequist U., Björling G., Linder H., Svärd K. O., Tysk L. A double-blind randomized study of clomipramine versus maprotiline in patients with idiopathic pain syndromes. Neuropsychobiology. 1988;19(1):25–34. doi: 10.1159/000118429. [DOI] [PubMed] [Google Scholar]
  9. Feinmann C., Harris M., Cawley R. Psychogenic facial pain: presentation and treatment. Br Med J (Clin Res Ed) 1984 Feb 11;288(6415):436–438. doi: 10.1136/bmj.288.6415.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Feinmann C. Pain relief by antidepressants: possible modes of action. Pain. 1985 Sep;23(1):1–8. doi: 10.1016/0304-3959(85)90223-4. [DOI] [PubMed] [Google Scholar]
  11. Fine P. G., Milano R., Hare B. D. The effects of myofascial trigger point injections are naloxone reversible. Pain. 1988 Jan;32(1):15–20. doi: 10.1016/0304-3959(88)90018-8. [DOI] [PubMed] [Google Scholar]
  12. Frost A. Diclofenac versus lidocaine as injection therapy in myofascial pain. Scand J Rheumatol. 1986;15(2):153–156. doi: 10.3109/03009748609102082. [DOI] [PubMed] [Google Scholar]
  13. Gessel A. H. Electromygraphic biofeedback and tricyclic antidepressants in myofascial pain-dysfunction syndrome: psychological predictors of outcome. J Am Dent Assoc. 1975 Nov;91(5):1048–1052. doi: 10.14219/jada.archive.1975.0512. [DOI] [PubMed] [Google Scholar]
  14. Glassman A. H., Bigger J. T., Jr Cardiovascular effects of therapeutic doses of tricyclic antidepressants. A review. Arch Gen Psychiatry. 1981 Jul;38(7):815–820. doi: 10.1001/archpsyc.1981.01780320095011. [DOI] [PubMed] [Google Scholar]
  15. Goldenberg D. L., Felson D. T., Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum. 1986 Nov;29(11):1371–1377. doi: 10.1002/art.1780291110. [DOI] [PubMed] [Google Scholar]
  16. Gomersall J. D., Stuart A. Amitriptyline in migraine prophylaxis. Changes in pattern of attacks during a controlled clinical trial. J Neurol Neurosurg Psychiatry. 1973 Aug;36(4):684–690. doi: 10.1136/jnnp.36.4.684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Greene C. S., Laskin D. M. Long-term evaluation of treatment for myofascial pain-dysfunction syndrome: a comparative analysis. J Am Dent Assoc. 1983 Aug;107(2):235–238. doi: 10.14219/jada.archive.1983.0246. [DOI] [PubMed] [Google Scholar]
  18. Greene C. S., Laskin D. M. Long-term status of TMJ clicking in patients with myofascial pain and dysfunction. J Am Dent Assoc. 1988 Sep;117(3):461–465. doi: 10.1016/s0002-8177(88)73018-4. [DOI] [PubMed] [Google Scholar]
  19. Hameroff S. R., Cork R. C., Scherer K., Crago B. R., Neuman C., Womble J. R., Davis T. P. Doxepin effects on chronic pain, depression and plasma opioids. J Clin Psychiatry. 1982 Aug;43(8 Pt 2):22–27. [PubMed] [Google Scholar]
  20. Hameroff S. R., Weiss J. L., Lerman J. C., Cork R. C., Watts K. S., Crago B. R., Neuman C. P., Womble J. R., Davis T. P. Doxepin's effects on chronic pain and depression: a controlled study. J Clin Psychiatry. 1984 Mar;45(3 Pt 2):47–53. [PubMed] [Google Scholar]
  21. Hersh E. V. Tricyclic antidepressant drugs: pharmacologic implications in the treatment of chronic orofacial pain. Compendium. 1987 Oct;8(9):688, 690, 692-4. [PubMed] [Google Scholar]
  22. Kellar K. J., Cascio C. S., Bergstrom D. A., Butler J. A., Iadarola P. Electroconvulsive shock and reserpine: effects on beta-adrenergic receptors in rat brain. J Neurochem. 1981 Oct;37(4):830–836. doi: 10.1111/j.1471-4159.1981.tb04468.x. [DOI] [PubMed] [Google Scholar]
  23. Kellar K. J., Stockmeier C. A. Effects of electroconvulsive shock and serotonin axon lesions on beta-adrenergic and serotonin-2 receptors in rat brain. Ann N Y Acad Sci. 1986;462:76–90. doi: 10.1111/j.1749-6632.1986.tb51242.x. [DOI] [PubMed] [Google Scholar]
  24. Kreisberg M. K. Tricyclic antidepressants: analgesic effect and indications in orofacial pain. J Craniomandib Disord. 1988 Fall;2(4):171–177. [PubMed] [Google Scholar]
  25. Kvinesdal B., Molin J., Frøland A., Gram L. F. Imipramine treatment of painful diabetic neuropathy. JAMA. 1984 Apr 6;251(13):1727–1730. [PubMed] [Google Scholar]
  26. Lamey P. J., Lamb A. B. The usefulness of the HAD scale in assessing anxiety and depression in patients with burning mouth syndrome. Oral Surg Oral Med Oral Pathol. 1989 Apr;67(4):390–392. doi: 10.1016/0030-4220(89)90379-4. [DOI] [PubMed] [Google Scholar]
  27. Lance J. W., Curran D. A., Anthony M. Investigations into the mechanism and treatment of chronic headache. Med J Aust. 1965 Nov 27;2(22):909–914. [PubMed] [Google Scholar]
  28. Langohr H. D., Stöhr M., Petruch F. An open and double-blind cross-over study on the efficacy of clomipramine (Anafranil) in patients with painful mono- and polyneuropathies. Eur Neurol. 1982;21(5):309–317. doi: 10.1159/000115497. [DOI] [PubMed] [Google Scholar]
  29. Leysen J. E., Awouters F., Kennis L., Laduron P. M., Vandenberk J., Janssen P. A. Receptor binding profile of R 41 468, a novel antagonist at 5-HT2 receptors. Life Sci. 1981 Mar 2;28(9):1015–1022. doi: 10.1016/0024-3205(81)90747-5. [DOI] [PubMed] [Google Scholar]
  30. Max M. B., Culnane M., Schafer S. C., Gracely R. H., Walther D. J., Smoller B., Dubner R. Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology. 1987 Apr;37(4):589–596. doi: 10.1212/wnl.37.4.589. [DOI] [PubMed] [Google Scholar]
  31. Merskey H., Hester R. A. The treatment of chronic pain with psychotropic drugs. Postgrad Med J. 1972 Oct;48(564):594–598. doi: 10.1136/pgmj.48.564.594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Moore D. P. Treatment of chronic pain with tricyclic antidepressants. South Med J. 1980 Dec;73(12):1585–1586. doi: 10.1097/00007611-198012000-00015. [DOI] [PubMed] [Google Scholar]
  33. Pilowsky I., Barrow C. G. A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, 'psychogenic' pain. Pain. 1990 Jan;40(1):3–19. doi: 10.1016/0304-3959(90)91045-K. [DOI] [PubMed] [Google Scholar]
  34. Pilowsky I., Hallett E. C., Bassett D. L., Thomas P. G., Penhall R. K. A controlled study of amitriptyline in the treatment of chronic pain. Pain. 1982 Oct;14(2):169–179. doi: 10.1016/0304-3959(82)90097-5. [DOI] [PubMed] [Google Scholar]
  35. Rosenblatt R. M., Reich J., Dehring D. Tricyclic antidepressants in treatment of depression and chronic pain: analysis of the supporting evidence. Anesth Analg. 1984 Nov;63(11):1025–1032. [PubMed] [Google Scholar]
  36. Schmauss C., Hammond D. L., Ochi J. W., Yaksh T. L. Pharmacological antagonism of the antinociceptive effects of serotonin in the rat spinal cord. Eur J Pharmacol. 1983 Jun 17;90(4):349–357. doi: 10.1016/0014-2999(83)90556-3. [DOI] [PubMed] [Google Scholar]
  37. Sharav Y., Singer E., Schmidt E., Dionne R. A., Dubner R. The analgesic effect of amitriptyline on chronic facial pain. Pain. 1987 Nov;31(2):199–209. doi: 10.1016/0304-3959(87)90036-4. [DOI] [PubMed] [Google Scholar]
  38. Stockmeier C. A., Kellar K. J. Electroconvulsive shock decreases beta-adrenoceptors despite serotonin lesions. Eur J Pharmacol. 1988 Aug 9;153(1):135–139. doi: 10.1016/0014-2999(88)90598-5. [DOI] [PubMed] [Google Scholar]
  39. Taub A. Relief of postherpetic neuralgia with psychotropic drugs. J Neurosurg. 1973 Aug;39(2):235–239. doi: 10.3171/jns.1973.39.2.0235. [DOI] [PubMed] [Google Scholar]
  40. Theesen K. A., Marsh W. R. Relief of diabetic neuropathy with fluoxetine. DICP. 1989 Jul-Aug;23(7-8):572–574. doi: 10.1177/1060028089023007-808. [DOI] [PubMed] [Google Scholar]
  41. Watson C. P., Evans R. J. A comparative trial of amitriptyline and zimelidine in post-herpetic neuralgia. Pain. 1985 Dec;23(4):387–394. doi: 10.1016/0304-3959(85)90009-0. [DOI] [PubMed] [Google Scholar]
  42. Watson C. P., Evans R. J., Reed K., Merskey H., Goldsmith L., Warsh J. Amitriptyline versus placebo in postherpetic neuralgia. Neurology. 1982 Jun;32(6):671–673. doi: 10.1212/wnl.32.6.671. [DOI] [PubMed] [Google Scholar]
  43. Woodforde J. M., Dwyer B., McEwen B. W., De Wilde F. W., Bleasel K., Connelley T. J., Ho C. Y. Treatment of post-herpetic neuralgia. Med J Aust. 1965 Nov 20;2(21):869–872. [PubMed] [Google Scholar]
  44. Yaksh T. L., Wilson P. R. Spinal serotonin terminal system mediates antinociception. J Pharmacol Exp Ther. 1979 Mar;208(3):446–453. [PubMed] [Google Scholar]
  45. Zilli C., Brooke R. I., Lau C. L., Merskey H. Screening for psychiatric illness in patients with oral dysesthesia by means of the General Health Questionnaire--twenty-eight item version (GHQ-28) and the Irritability, Depression and Anxiety Scale (IDA). Oral Surg Oral Med Oral Pathol. 1989 Apr;67(4):384–389. doi: 10.1016/0030-4220(89)90378-2. [DOI] [PubMed] [Google Scholar]
  46. de Felipe M. C., de Ceballos M. L., Fuentes J. A. Hypoalgesia induced by antidepressants in mice: a case for opioids and serotonin. Eur J Pharmacol. 1986 Jun 17;125(2):193–199. doi: 10.1016/0014-2999(86)90027-0. [DOI] [PubMed] [Google Scholar]
  47. van de Merwe T. J., Silverstone T., Ankier S. I., Warrington S. J., Turner P. A double-blind non-crossover placebo-controlled study between group comparison of trazodone and amitriptyline on cardiovascular function in major depressive disorder. Psychopathology. 1984;17 (Suppl 2):64–76. doi: 10.1159/000284094. [DOI] [PubMed] [Google Scholar]

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