Journal of clinical psychopharmacology
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J Clin Psychopharmacol · Apr 2007
Randomized Controlled TrialEfficacy of noradrenergic and serotonergic antidepressants in chronic back pain: a preliminary concentration-controlled trial.
Although antidepressants are widely prescribed as analgesics in chronic back pain, their clinical pharmacology is not well established. Norepinephrine transporter blockade seems to be essential for analgesia, but optimal concentrations are unknown. Fixed-dose studies of serotonin reuptake inhibitors are generally negative, but such studies cannot be interpreted clearly because efficacy might be detected if concentration-response relationships were known. We evaluated (1) the feasibility of conducting a controlled-concentration study of a norepinephrine (desipramine) and a serotonin reuptake (fluoxetine) inhibitor and (2) the relationship between achieved concentrations and analgesic response. ⋯ Preliminary evidence for a low-concentration "therapeutic window" for noradrenergic analgesia may warrant additional study.