NORTRIPTYLINE VERSUS AMITRIPTYLINE IN POSTHERPETIC NEURALGIA - A RANDOMIZED TRIAL

Objective (Background): Amitriptyline (AT) is a standard therapy for p ostherpetic neuralgia (PHN). Our hypothesis was that nortriptyline (NT ), a noradrenergic metabolite of AT, may be more effective. Methods: A randomized, double-blind, crossover trial of AT versus NT was conduct ed in 33 patients. Results: Thirty-one patients completed the trial. T wenty-one of 31 (67.7%) had at least a good response to AT or NT, or b oth. We found no difference with regard to relief of steady, brief, or skin pain by visual analog scales for pain and pain relief; mood; dis ability; satisfaction; or preference between the two drugs. Intolerabl e side effects were more common with AT. Most patients (26/33) were no t depressed, and most responding showed no change in rating scales for depression despite the occurrence of pain relief. Conclusions: We con cluded that this study provides a scientific basis for an analgesic ac tion of NT in PHN because pain relief occurred without an antidepressa nt effect, and that although there were fewer side effects with NT, AT and NT appear to have a similar analgesic action for most individuals .