Review. Clomipramine in acute and chronic pain syndromes

Abstract

The literature on the use of the antidepressant clomipramine (ANAFRANIL) in acute and chronic pain syndromes has been reviewed. The material includes 29 open clinical studies comprising 1090 patients and thirteen single or double blind controlled studies comprising 716 patients. The overall effect in the open studies is about 60–100% improvement. In the controlled studies a significantly better effect of clomipramine (CMI) was shown versus comparative drugs (placebo, acetylsalicylic acid, amitriptyline, maprotiline, mianserin and nortriptyline). No significant difference was found vs. amitriptyline in one study of neurogenic pain and vs. maprotiline in pain in depression. No significant effect was observed vs. placebo in one study of musculoskeletal pain and one of cancer pain. The dose of CMI ranged between 25–175 mg/day; doses of less than 100 mg/day was frequently used. The onset of action occurred in many cases within one week and poor information was given about the proper treatment time. The analgesic effect of CMI was in many cases independent of any depressive symptoms. The authors conclude that CMI can be of viable help in the management of chronic pain.

□ Antidepressants, Chronic pain, Clomipramine, Efficacy, Pain.