What are adverse effects of tricyclic antidepressants (TCAs) in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

The usefulness of TCAs is limited, particularly in geriatric populations, due to cardiovascular effects such as tachycardia; anticholinergic side effects including dry mouth, increased intraocular pressure, and constipation; oversedation; and dizziness, including orthostatic hypotension. [112] SSRIs should be considered for a variety of symptoms that commonly accompany chronic pain including reduced coping, depression, anxiety, and fatigue. [112] Overall, SSRIs have fewer adverse side effects than TCAs. Side effects associated with SSRIs include anxiety, nervousness, and insomnia; drowsiness and fatigue; tremor; increased sweating; appetite and gastrointestinal dysfunction; and male sexual dysfunction. Many pain specialists still consider TCAs as first-line pain medications for the treatment of persistent neuropathic pain, especially as an adjunct to peripheral therapies and to manage the adverse influences of chronic illness.


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