What is the role of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) in the treatment of complex regional pain syndrome (CRPS)?

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

TCAs have been studied at length for various neuropathic conditions, including diabetic neuropathy and postherpetic neuralgia, but not in CRPS. Serotonin and norepinephrine reuptake inhibitors, such as amitriptyline, and more selective norepinephrine reuptake inhibitors, such as desipramine, have demonstrated benefit in both of the aforementioned neuropathic pain models. Amitriptyline has been shown to be active in central pain and painful posttraumatic neuropathy. Usually, analgesic dosages are lower than those required for antidepressant effects (eg, 75-100 mg/d of amitriptyline with onset of pain relief in about 2 wk and peaking at 4-6 wk). The effectiveness of SSRIs for significantly reducing neuropathic pain has not been demonstrated. No studies have been performed in patients with CRPS. [59]


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