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.. Diabetic neuropathy: Effectiveness of amitriptyline and gabapentin. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.8, pp.38-52. ISSN 1134-8046.
Neuropathic pain is a form of chronic pain that has a great impact on the patients. Diabetes mellitus is one of the major causes of neuropathic pain. It is one of the most complex painful syndromes, with different symptoms and signs that vary over time both in their number and severity. The accompanying clinical signs affect the social and occupational activity of the patient, with the resulting decrease in the quality of life. Its treatment is difficult and, in general, unsatisfactory due to the lack of knowledge regarding its pathophysiological mechanisms. Antidepressants have been, up to now, the first-line drugs, but given its limited effectiveness and side effects, other therapeutic alternatives have been looked for. Through a search in the Medline database, we reviewed controlled trials that study the effectiveness of amitriptyline and gabapentin for the management of painful diabetic neuropathy. Antidepressants have been considered for years the first-line treatment for neuropathic pain in the diabetic patient, amitriptyline being the most widely used. Antiepileptics are increasingly important the management of this type of pain and they are believed to be the most effective ones. The anticolinergic side effects of amitriptyline restrict its use, the most common side effects being dizziness and somnolence, so it seems to be a good alternative as first-line treatment for neuropathic pain in aged patients. Just 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. Gabapentin can also be considered a first-line treatment for neuropathic pain in the diabetic. The election of one or the other drug must be made in each individual case based on the risk-benefit relation.
Palabras clave : Neuropathic pain; Diabetic; Gabapentin; Amitriptyline.