BibTex RIS Cite

Antiepileptic and Antidepressant Drugs in the Treatment of Neuropathic Pain and Depression of the Patients with Diabetic Neuropathy: A Comparative Study

Year 2011, Volume: 18 Issue: 3, 149 - 154, 01.06.2011

Yıldız Değirmenci Hulusi Keçeci Handan Işın Özışık Karaman

Abstract

Objective: The aim of this study is to investigate the effects of two antidepressants; amitryptline, venlafaxine XR, and two anticonvulsants lamotrigine, oxcarbazepine on pain and depression in diabetic neuropathy (DN). Material and methods: Following the visual analog scale (VAS), Short-McGill pain questionnaire (SMPQ) and Beck depression inventory (BDI) performance, patients with diabetic neuropathy were randomly treated with lamotrigine (2x50 mg/day), oxcarbazepine (2x300 mg/day), amitryptiline (25 mg/day), or venlafaxine XR (75 mg/day). Patients presented to 6 follow-up visits, within 15 days of intervals. VAS scores were re-measured in each follow-up visits, whereas SMPQ and BDI scores were performed at the end of the study. Results: There were statistically significant differences between the BDI and SMPQ scores of the all study groups before treatment and at the last follow-up visit (p<0.05).Initial VAS scores were similar in the study groups, whereas VAS scores in the day 15, 30 and 90 revealed statistically significant differences in all groups (p<0.05). Lamotrigine and oxcarbazepine were found as effective as amitryptiline and venlafaxine XR on depression. Conclusion: Similar efficacity of antiepileptic and antidepressants in the precence of painful DN and depression is important to contribute in personalization of the treatments and to increase the therapeutic options. Key words: Diabetic Neuropathy; Depression; Oxcarbazepine; Lamotrigine; Venlafaxine; Amitriptyline.

Keywords

Diabetic Neuropathy; Depression; Oxcarbazepine; Lamotrigine; Venlafaxine; Amitriptyline.

References

  • Gries FA, Cameron NE, Low PA. Diabetes Mellitus. In: Gries FA, ed. Textbook of Diabetic Neuropathy 2003. p. 1-16.
  • Satman I, Yilmaz T, Sengul A, Salman S, Salman F, Uygur S, et. al. Population-based study of diabetes and risk characteristics in Turkey. Diabetes Care 2002; 25 (9): 1551-56.
  • Feldman EL, Stevens MJ, Russell JW, Greene DA. Diabetic neuropathy. In: Taylor S, ed. Current review of diabetes. Current Medicine, 2nd edition, Philedelphia; 1999. p. 71-82.
  • Erbas T, Ertas M, Yucel A, Keskinaslan A, Senocak M; TURNEP Study Group. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. J Clin Neurophysiol 2011; 28(1): 1-5.
  • Dacosta Dibonaventura M, Cappelleri JC, Joshi AV. A longitudinal assessment of painful diabetic peripheral neuropathy on health status, productivity, and health care utilization and cost. Pain Med 2011; 12(1): 118-26.
  • Dyck PJ, Overland CJ, Low PA, et al CI vs NPhys Trial Investigators, Albers JW, Anderson H, Bolton CF, et al Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial. Muscle Nerve 2010; 42(2): 157-64.
  • Barbano R, Hart-Gouleau S, Pennella-Vaughan J, Dworkin RH. Pharmacotherapy of painful diabetic neuropathy. Curr Pain Headache Rep 2003; 7(3): 169-77.
  • Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993; 329: 977-86.
  • Spruce MC, Potter J, Coppini DV. The pathogenesis and management of painful diabetic neuropathy: a review. Diabet Med 2003; 20(2): 88-98.
  • Craner MJ, Klein JP, Renganathan M, Black JA, Waxman SG. Changes of sodium channel expression in experimental painful diabetic neuropathy. Ann Neurol 2002;52 (6):786-92.
  • Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms and management. Lancet 1999; 353 (9168): 1959-64.
  • Lindsay TJ, Rodgers BC, Savath V, Hettinger K. Treating diabetic peripheral neuropathic pain. Am Fam Physician 2010;15;82(2):151-8.
  • Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? Neuroendocrinol 2001; 13 (12): 1009-1023.
  • Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13 (2):116-37.
  • Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997; 20 (4): 585-90.
  • Vileikyte L, Leventhal H, Gonzalez JS, et al. Diabetic peripheral neuropathy and depressive symptoms. The association revisited. Diabetes Care 2005; 28(10): 2378-83.
  • Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes A meta-analysis. Diabetes Care 2001; 24(6): 1069-78.
  • Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23 (7): 434-42.
  • Jayaprakash P, Bhansali A, Bhansali S, et al. Validation of bedside methods in evaluation of diabetic peripheral neuropathy. Indian J Med Res 2011; 133(6): 645-9.
  • Köknel Talu G. [Evaluation of patients with pain]. Erdine S, editor. Ağrı. 3. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2007. p. 61-69.
  • Arkar H. The relationship between depressive mood and personality: Comparison of the Beck Depression Inventory and the Temperament and Character Inventory. New Symp J 2010; 48 (2): 116-21.
  • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1999; 22(1): 5-19.
  • Ross EL. The evolving role of antiepileptic drugs in treating neuropathic pain. Neurology 2000; 55 (5 Suppl 1): S41-46.
  • Troels SJ. Anticonvulsants in neuropathic pain: rationale and clinical evidence. Eur J Pain 2002; 6 (Suppl. A): 61-68.
  • Erdine S. Physical examination of patients with pain. Erdine S, editor. Ağrı Sendromları ve Tedavisi. Genisletilmiş 2. Baskı. Ankara: Gizben Matbaacılık; 2003. p. 11-27.
  • Low P, Dotson R. Symptom treatment of painful neuropathy. JAMA 1998; 280 (21): 1863-64.
  • Chan HN, Fam J, Ng BY. Use of antidepressants in the treatment of chronic pain. Ann Acad Med Singapore 2009; 38(11): 974-9.
  • Backonja MM, Serra J. Pharmacologic management part 1: Better-studied neuropathic pain diseases. Pain Medicine 2004; 5(S1): 28-47.
  • Max MB, Culnane M, Schafer SC, Gracely RH, Walther DJ. Amitriptyline relieves diabetik neuropathy pain in patients with normal or depressed mood. Neurology 1987; 37 (4): 589-96.
  • Dalgıç H, Papak Ö. [Analgesic/antinociceptive mechanism of action of tricyclic antidepressants]. Erciyes Tıp Dergisi 2003; 25 (2): 98-103.
  • Kiayias JA, Vlachou ED, Lakka-Papadodima E. Venlafaxine HCl in the treatment of painful peripheral diabetic neuropathy. Diabetes Care 2000; 23 (5): 699-702.
  • Tasmuth T, Hartel B, Kalso E. Venlafaxine in neuropathic pain following treatment of breast cancer. Eur J Pain 2002; 6 (1): 17- 24.
  • Rowbotham MC, Goli V, Kunz NR, Lei D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo controlled study. Pain 2004; 110 (3): 697- 706.
  • Stefani A, Pisani A, De Mutas M. Action of GP47779, the active metabolite of oxcarbezapine on the corticostriatal system II. Modulation of high-voltage activated calcium currents. Epilepsia 1995; 36 (10): 997-1002.
  • Ichikawa K, Koyama N, Kigushi S, Kojima M, Yokota T. Inhibitory effect of oxcarbezapine on high-frequency firing in peripheral nerve fibers. Eur J Pharmacol 2001; 420 (2-3): 119- 122.
  • Beydoun A, Kobetz SA, Carrazana EJ. Efficacy of oxcarbezapine in the treatment of painful diabetic neuropathy. Clin J Pain 2004; 20(3): 174-178.
  • Eisenberg E, Lurie Y, Braker C, Daoud D, Isshay A. Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology 2001; 57 (3): 505-9.
  • Eisenberg E, Alon N, Ishay A, Daoud D, Yarnitsky D. Lamotrigine in the treatment of painful diabetic neuropathy. Eur J Neurol 1998; 5(2): 167-73.

Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması

Year 2011, Volume: 18 Issue: 3, 149 - 154, 01.06.2011

Yıldız Değirmenci Hulusi Keçeci Handan Işın Özışık Karaman

Abstract

Amaç: Bu çalışmada, diyabetik nöropati (DN) hastalarında antidepresan olan amitriptilin ve venlafaksin SR ile antiepileptik olan lamotirijin ve okskarbazepinin ağrı ve depresyon üzerindeki etkilerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Diyabetik nöropati tanısı konmuş hastalara nöropatik ağrı değerlendirmesine yönelik vizüel analog skala (VAS) ve Short-McGill ağrı anketi (SMAA) ile birlikte depresyon değerlendirmesinde kullanılan Beck Depresyon Envanteri (BDE) uygulanmasını takiben, rastgele ve randomize bir şekilde lamotrijin (2x50 mg/gün), okskarbazepin (2x300 mg/gün), amitriptilin (25 mg/gün) ve venlafaksin SR (75 mg/gün) tedavi rejimlerinden biri başlanmıştır. Hastalar 15 günlük aralarla toplam 6 kez kontrole çağrılmış ve her kontrolde VAS skorları ölçülmüştür. 6. ve son kontrolde ise VAS'a ek olarak SMAA ve BDE skorları ölçülmüştür. Bulgular:Tüm gruplarda, tedavi öncesi ve tedavi sonrası son BDE ve SMAA değerleri arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p<0.05). Başlangıç VAS skorları benzer olan tüm tedavi gruplarında, 15. ve 30. ve 90. günlerde yapılan değerlendirmelerde VAS skorlarının tüm gruplar arasında istatistiksel olarak anlamlı farklılık gösterdiği saptanmıştır (p<0.05). Sonuç olarak lamotirijin ve okskarbazepin depresyon üzerinde amitriptilin ve venlafaksin SR kadar etkili olduğu bulunmuştur. Sonuç: Ağrılı DN ve eşlik eden depresyon varlığında antiepileptik ve antidepresanların benzer etkili olmaları tedavi alternatiflerinin arttırılması ve tedavinin kişiselleştirilmesine katkıda bulunması açısından önemlidir. Anahtar kelimeler: Diyabetik Nöropati; Depresyon; Okskarbazepin; Lamotrijin; Venlafaksin; Amitriptilin.

Keywords

Diyabetik Nöropati; Depresyon; Okskarbazepin; Lamotrijin; Venlafaksin; Amitriptilin.

References

  • Gries FA, Cameron NE, Low PA. Diabetes Mellitus. In: Gries FA, ed. Textbook of Diabetic Neuropathy 2003. p. 1-16.
  • Satman I, Yilmaz T, Sengul A, Salman S, Salman F, Uygur S, et. al. Population-based study of diabetes and risk characteristics in Turkey. Diabetes Care 2002; 25 (9): 1551-56.
  • Feldman EL, Stevens MJ, Russell JW, Greene DA. Diabetic neuropathy. In: Taylor S, ed. Current review of diabetes. Current Medicine, 2nd edition, Philedelphia; 1999. p. 71-82.
  • Erbas T, Ertas M, Yucel A, Keskinaslan A, Senocak M; TURNEP Study Group. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. J Clin Neurophysiol 2011; 28(1): 1-5.
  • Dacosta Dibonaventura M, Cappelleri JC, Joshi AV. A longitudinal assessment of painful diabetic peripheral neuropathy on health status, productivity, and health care utilization and cost. Pain Med 2011; 12(1): 118-26.
  • Dyck PJ, Overland CJ, Low PA, et al CI vs NPhys Trial Investigators, Albers JW, Anderson H, Bolton CF, et al Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial. Muscle Nerve 2010; 42(2): 157-64.
  • Barbano R, Hart-Gouleau S, Pennella-Vaughan J, Dworkin RH. Pharmacotherapy of painful diabetic neuropathy. Curr Pain Headache Rep 2003; 7(3): 169-77.
  • Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993; 329: 977-86.
  • Spruce MC, Potter J, Coppini DV. The pathogenesis and management of painful diabetic neuropathy: a review. Diabet Med 2003; 20(2): 88-98.
  • Craner MJ, Klein JP, Renganathan M, Black JA, Waxman SG. Changes of sodium channel expression in experimental painful diabetic neuropathy. Ann Neurol 2002;52 (6):786-92.
  • Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms and management. Lancet 1999; 353 (9168): 1959-64.
  • Lindsay TJ, Rodgers BC, Savath V, Hettinger K. Treating diabetic peripheral neuropathic pain. Am Fam Physician 2010;15;82(2):151-8.
  • Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? Neuroendocrinol 2001; 13 (12): 1009-1023.
  • Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13 (2):116-37.
  • Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997; 20 (4): 585-90.
  • Vileikyte L, Leventhal H, Gonzalez JS, et al. Diabetic peripheral neuropathy and depressive symptoms. The association revisited. Diabetes Care 2005; 28(10): 2378-83.
  • Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes A meta-analysis. Diabetes Care 2001; 24(6): 1069-78.
  • Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23 (7): 434-42.
  • Jayaprakash P, Bhansali A, Bhansali S, et al. Validation of bedside methods in evaluation of diabetic peripheral neuropathy. Indian J Med Res 2011; 133(6): 645-9.
  • Köknel Talu G. [Evaluation of patients with pain]. Erdine S, editor. Ağrı. 3. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2007. p. 61-69.
  • Arkar H. The relationship between depressive mood and personality: Comparison of the Beck Depression Inventory and the Temperament and Character Inventory. New Symp J 2010; 48 (2): 116-21.
  • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1999; 22(1): 5-19.
  • Ross EL. The evolving role of antiepileptic drugs in treating neuropathic pain. Neurology 2000; 55 (5 Suppl 1): S41-46.
  • Troels SJ. Anticonvulsants in neuropathic pain: rationale and clinical evidence. Eur J Pain 2002; 6 (Suppl. A): 61-68.
  • Erdine S. Physical examination of patients with pain. Erdine S, editor. Ağrı Sendromları ve Tedavisi. Genisletilmiş 2. Baskı. Ankara: Gizben Matbaacılık; 2003. p. 11-27.
  • Low P, Dotson R. Symptom treatment of painful neuropathy. JAMA 1998; 280 (21): 1863-64.
  • Chan HN, Fam J, Ng BY. Use of antidepressants in the treatment of chronic pain. Ann Acad Med Singapore 2009; 38(11): 974-9.
  • Backonja MM, Serra J. Pharmacologic management part 1: Better-studied neuropathic pain diseases. Pain Medicine 2004; 5(S1): 28-47.
  • Max MB, Culnane M, Schafer SC, Gracely RH, Walther DJ. Amitriptyline relieves diabetik neuropathy pain in patients with normal or depressed mood. Neurology 1987; 37 (4): 589-96.
  • Dalgıç H, Papak Ö. [Analgesic/antinociceptive mechanism of action of tricyclic antidepressants]. Erciyes Tıp Dergisi 2003; 25 (2): 98-103.
  • Kiayias JA, Vlachou ED, Lakka-Papadodima E. Venlafaxine HCl in the treatment of painful peripheral diabetic neuropathy. Diabetes Care 2000; 23 (5): 699-702.
  • Tasmuth T, Hartel B, Kalso E. Venlafaxine in neuropathic pain following treatment of breast cancer. Eur J Pain 2002; 6 (1): 17- 24.
  • Rowbotham MC, Goli V, Kunz NR, Lei D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo controlled study. Pain 2004; 110 (3): 697- 706.
  • Stefani A, Pisani A, De Mutas M. Action of GP47779, the active metabolite of oxcarbezapine on the corticostriatal system II. Modulation of high-voltage activated calcium currents. Epilepsia 1995; 36 (10): 997-1002.
  • Ichikawa K, Koyama N, Kigushi S, Kojima M, Yokota T. Inhibitory effect of oxcarbezapine on high-frequency firing in peripheral nerve fibers. Eur J Pharmacol 2001; 420 (2-3): 119- 122.
  • Beydoun A, Kobetz SA, Carrazana EJ. Efficacy of oxcarbezapine in the treatment of painful diabetic neuropathy. Clin J Pain 2004; 20(3): 174-178.
  • Eisenberg E, Lurie Y, Braker C, Daoud D, Isshay A. Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology 2001; 57 (3): 505-9.
  • Eisenberg E, Alon N, Ishay A, Daoud D, Yarnitsky D. Lamotrigine in the treatment of painful diabetic neuropathy. Eur J Neurol 1998; 5(2): 167-73.
There are 38 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Yıldız Değirmenci This is me

Hulusi Keçeci This is me

Handan Işın Özışık Karaman This is me

Publication Date June 1, 2011
Published in Issue Year 2011 Volume: 18 Issue: 3

Cite

APA Değirmenci, Y., Keçeci, H., & Karaman, H. I. Ö. (2011). Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması. Journal of Turgut Ozal Medical Center, 18(3), 149-154.
AMA Değirmenci Y, Keçeci H, Karaman HIÖ. Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması. J Turgut Ozal Med Cent. June 2011;18(3):149-154.
Chicago Değirmenci, Yıldız, Hulusi Keçeci, and Handan Işın Özışık Karaman. “Diyabetik Nöropatili Hastaların Nöropatik Ağrı Ve Depresyon Tedavisinde, Antidepresan Ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması”. Journal of Turgut Ozal Medical Center 18, no. 3 (June 2011): 149-54.
EndNote Değirmenci Y, Keçeci H, Karaman HIÖ (June 1, 2011) Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması. Journal of Turgut Ozal Medical Center 18 3 149–154.
IEEE Y. Değirmenci, H. Keçeci, and H. I. Ö. Karaman, “Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması”, J Turgut Ozal Med Cent, vol. 18, no. 3, pp. 149–154, 2011.
ISNAD Değirmenci, Yıldız et al. “Diyabetik Nöropatili Hastaların Nöropatik Ağrı Ve Depresyon Tedavisinde, Antidepresan Ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması”. Journal of Turgut Ozal Medical Center 18/3 (June 2011), 149-154.
JAMA Değirmenci Y, Keçeci H, Karaman HIÖ. Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması. J Turgut Ozal Med Cent. 2011;18:149–154.
MLA Değirmenci, Yıldız et al. “Diyabetik Nöropatili Hastaların Nöropatik Ağrı Ve Depresyon Tedavisinde, Antidepresan Ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması”. Journal of Turgut Ozal Medical Center, vol. 18, no. 3, 2011, pp. 149-54.
Vancouver Değirmenci Y, Keçeci H, Karaman HIÖ. Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması. J Turgut Ozal Med Cent. 2011;18(3):149-54.