Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
VIDAL, M. A.; MARTINEZ-FERNANDEZ, E.; MARTINEZ-VAZQUEZ DE CASTRO, J. y TORRES, L. M.. Effectiveness of gabapentine and amytriptiline in the diabetic neuropathic pain. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.5, pp.292-305. ISSN 1134-8046.
Neuropathic pain is a type of chronic pain that has a great impact on the patients. Diabetes mellitus is one of the main causes of neuropathic pain. It is one of the most complex pain syndromes, with diverse symptoms and signs that change over time both in number and severity. It is usually associated to clinical manifestations that interfere with social and job activity, with the resulting impairment of quality of life. Its treatment is difficult and, in general, scarcely satisfactory due to the lack of knowledge regard-ing its physiopathological mechanisms. Antidepressants have been considered until now as the first-line drugs, but due to their limited effectiveness and their side effects, therapeutic alternatives have been looked for. Through a search in the Medline database, we reviewed controlled trials that have studied the effectiveness of amytriptiline and gabapentine (GBP) for the management of diabetic neuropathic pain. For years, antidepressants have been considered the best drugs for this type of pain, amytriptiline being the most frequently used. Currently, anti-epileptics are being increasingly used for the management of this type of pain, and GBP seems to be the most effective one. Anticholinergic side effects of the amytriptiline restrict its use, particularly in aged patients. GBP seems to be a well-tolerated drug, with dizziness and somnolence as its most frequent side effects, so it seems to be a good alternative as first-line therapy for neuropathic pain in aged patients. Only two controlled and randomized studies have been published that compare both treatments. However, these studies cannot be considered conclusive due to their small sample size. GBP can be considered the first-line treatment for diabetic neuropathic pain. The medication must be decided individually for each patient, based on the risk-benefit ratio.
Palabras clave : Neuropathic pain; Diabetic; Gabapentine; Amytriptiline.