Maizels M, McCarberg B: Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician 2005;71(3):483-90.
The authors review the appropriate use of the newer classes of antidepressant and second-generation antiepileptic drugs, which modulate pain transmission by interacting with specific neurotransmitters and ion channels. Before choosing drug therapy, the prescriber must distinguish between chronic pain that results from injury or inflammation compared to neuropathic pain. Anti-depressant and antiepileptic drugs have comparable efficacy in patients with neuropathic pain, but they differ in safety, tolerability, and side effect profiles. Patients with nociceptive pain should be treated with anti-inflammatory or analgesic medications since antidepressant or antiepileptic drugs, with the exception of tricyclic antidepressants, have little documented effectiveness for this type of pain. In general, second generation antiepileptic drugs such as gabapentin and lamotrigine are better tolerated than first generation agents such as carbamazepine, cause less sedation, and have fewer central nervous system side effects. The tabular displays of dosage and side effect profiles including approved and unapproved antidepressant and antiepileptic drugs will help providers choose drug therapy for chronic pain syndromes.