A guide to the understanding & use of tricyclic antidepressants in the overall management of fibromyalgia (FM) & other chronic pain syndromes

The purpose of this review is to present relatively detailed

information on the characteristics of tricyclic

antidepressants, mainly amitriptyline hydrochloride and

doxepin hydrochloride, for use as an integral part of the safe

and effective management of fibromyalgia and, to a lesser

extent, other chronic pain syndromes. Data sources include

MEDLINE searches in English, relevant reference books and

textbooks, my personal database and library, as well as

personal clinical experience. I discuss these data with regard

to the pharmacologic characteristics, mechanisms of action,

adverse effects, and precautions involved with the use of

tricyclic antidepressants. Additional information is given on

drug selection and dosage titration. Much emphasis is placed

on the fact that while tricyclic antidepressants play a major

role in the management of fibromyalgia and other chronic pain

syndromes, lifestyle alterations (eg. physical reconditioning

and exercise), as well as behavior modification, are also

vital to a successful outcome in management. [References: 44]

Godfrey RG

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