Chronic Pain and Tricyclic Antidepressants

Excerpt

To the editor: We read with interest the recent article (1) on the management of patients with chronic pain syndromes. The authors review the use of psychoactive medications in certain patients with pain syndromes and conclude that "the combination of a tricyclic antidepressant with a substituted phenothiazine or a butyrophenone . . . seems to be more efficacious than either drug alone." Due to the potential risks from long-term neuroleptic use, we feel that it is essential to evaluate the benefits versus the risks associated with the use of such agents.

There are numerous reports that tricyclic antidepressants may be