Bril, V, England, J, Franklin, GM, Backonja, M, Cohen, J, Del Toro, D et al.; American Academy of Neurology; American Association of Neuromuscular and Electrodiagnostic Medicine; American Academy of Physical Medicine and Rehabilitation.. Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 76: 1758-1765

University Health Network, University of Toronto, Toronto, Ontario, Canada.
Muscle & Nerve (Impact Factor: 2.31). 06/2011; 43(6):910-7. DOI: 10.1002/mus.22092
Source: PubMed

ABSTRACT The objective of this report was to develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). The basic question that was asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" A systematic review of literature from 1960 to August 2008 was performed, and studies were classified according to the American Academy of Neurology classification of evidence scheme for a therapeutic article. Recommendations were linked to the strength of the evidence. The results indicate that pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence, or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness. Few studies have sufficient information on their effects on function and QOL.

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Available from: Vera Bril, Aug 24, 2015
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    • "The main mechanisms of analgesic action of VFX include an increase of the amount of noradrenaline and serotonin in the descending inhibitory pathways at supraspinal and spinal levels [6], as well as blocking of sodium channels and activating of m-and d-opioid receptors [7]. Morphine (MRF) is a strong opioid, which has unsatisfactory effect in painful diabetic neuropathy [5]. Hence, it is recommended in clinical practice to combine opioids and adjuvant drugs, such as antidepressants (AD) and antiepileptics [2]. "
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    ABSTRACT: Background: we investigated the possible mechanisms involved in the interactions of venlafaxine (VFX), a selective serotonin and noradrenaline reuptake inhibitor, and morphine (MRF), an opioid receptor agonist, after acute and chronic VFX treatment in diabetic neuropathic pain model (DNPM). Methods: The studies were performed on male rats. The changes in nociceptive thresholds were determined by using mechanical stimuli (the Randall-Selitto and the von Frey tests). Diabetes was induced by intramuscular administration of streptozotocin. In order to investigate the mechanism of interaction, animals were also pretreated with naloxone (NLX), a nonselective opioid antagonist, yohimbine (YOH), a nonselective alpha(2)-adrenergic antagonist, and p-chloroamphetamine (PCA), a neurotoxin that destroys serotonergic neurons. The mu-opioid receptors' density was determined with the use of radioligand binding assay. Results: VFX potentiated antinociceptive action of MRF after acute administration of VFX and this effect was decreased by pretreatment of NLX, YOH and PCA. On the contrary, VFX administered for 21 days prior to MRF significantly decreased the analgesic action of MRF; this effect was augmented only after YOU pretreatment. Also, 21-days administration of VFX caused decreasing tendency in the number of mu-opioid receptors in the brain stem. Conclusions: The results of our study show that single administration of VFX potentiates antinociceptive action of morphine in DNPM. This effect is probably mediated by both, noradrenergic and serotonergic systems. On the other hand, 21-days administration of VFX significantly decreases analgesic action of MRF. Moreover, there is a possibility that VFX acts as an antagonist of N-methyl-D-aspartate receptors.
    Pharmacological reports: PR 02/2015; 67(1). DOI:10.1016/j.pharep.2014.08.008 · 2.17 Impact Factor
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    • "Valproic acid is one of the most important antiepileptic agents (Stephen, 2003; Angalakuditi and Angalakuditi, 2011) applicable in antiepileptic maintenance treatment as well as in epileptic emergency cases such as acute seizures or status epilepticus (Wasterlain et al., 2011). Moreover, it is an established mood stabilizer used in the treatment of bipolar affective disorders (Dietrich and Emrich, 1998; Bowden, 2003), and additionally in nonpsychiatric indications such as vestibular migraine (Bisdorff, 2011) or painful diabetic neuropathy (Bril et al., 2011). "
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    ABSTRACT: Valproic acid and the antidepressants doxepin and venlafaxine are frequently used psychotropic drugs. In the literature, an influence of valproic acid on serum levels of antidepressants has been described, although studies have focused on amitriptyline. The authors assessed their therapeutic drug monitoring (TDM) database for patients receiving a combination of doxepin or venlafaxine and valproic acid and compared these sample with matched controls without valproic acid comedication in terms of the serum concentration of antidepressants. The mean dose-corrected serum concentration of doxepin+N-doxepin in 16 patients who received valproic acid comedication was higher (2.171±1.482 ng/ml/mg) than that in the matched controls (0.971±0.857 ng/ml/mg, P<0.003). We also found a significant correlation between valproic acid serum level and dose-corrected doxepin+N-doxepin serum level (Spearman's ρ r=0.602, P<0.014). The mean dose-corrected serum level of venlafaxine+O-desmethylvenlafaxine in 41 patients who received valproic acid comedication did not differ significantly from that of the matched controls (P<0.089), but there was a significant difference between both groups in the dose-corrected serum level of O-desmethylvenlafaxine (1.403±0.665 vs. 1.102±0.444, P<0.017). As a consequence, if a combination of valproic acid with doxepin or venlafaxine is administered, cautious dosing is advisable and TDM should be performed.
    International clinical psychopharmacology 12/2013; 29(4). DOI:10.1097/YIC.0000000000000025 · 3.10 Impact Factor
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    • "The patient was receiving treatment with fentanyl transdermal patch 25 í µí¼‡g/h every 72 h since 10 days and amitriptyline 25 mg BD for depression. The low dose of amitriptyline 25 mg BD was maintained due to its antidepressant [1] [2] as well as analgesic effects on chronic pain [3– 5] and especially painful diabetic limb [6] [7] [8] [9] [10] [11] [12]. "
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    ABSTRACT: We report a unique case of an adverse interaction between the oxazolidinone antibiotic linezolid, the tricyclic antidepressant amitriptyline and the opioid analgesic fentanyl in a 68-year-old woman with advanced ischemic peripheral arterial disease and sepsis, under empirical antibiotic treatment. We also summarize the current relevant literature as identified via PubMed, EMBASE, and PsycINFO as well as reference sections of selected articles.
    03/2013; 2013:617251. DOI:10.1155/2013/617251
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