Morphine/antidepressant combo tops monotherapy for chronic neuropathic pain relief

by Bruce Sylvester: Researchers report that a combination morphine and nortriptyline successfully relieves chronic neuropathic pain in 87 per cent of patients, and the efficacy of the combination is significantly better than either drug used as monotherapy. This research was published on April 7, 2015 in PAIN

“Chronic pain is an increasingly common problem and can exert disastrous personal, societal, and socio-economic impacts on patients, their families, and their communities,” said Ian Gilron, MD, lead author of the study, Director of Clinical Pain Research, Professor of Anesthesiology, and Biomedical Sciences, and Faculty in the Center for Neuroscience Studies at Queen’s University in Kingston, Ontario, Canada. “Current neuropathic pain treatments are ineffective or intolerable for many sufferers so this new evidence supporting the morphine-nortriptyline combination is important news for patients.”

For each 6-week phase of the 18-week study, subjects were treated with one of the three therapies, combination therapy, morphine monotherapy or nortriptyline monotherapy. Throughout the whole study subjects received ongoing pain/side-effect evaluations.

The researchers measured average daily pain using a patient’s numerical rating of pain on a validated scale from 0 — 10. They reported that average daily pain, which was 5.6 before combination treatment, dropped to 2.6 with combination treatment.

Notably, side effects for both drugs did not worsen during combination treatment.

“It’s important to remember that we don’t want to completely eliminate patients’ ability to sense pain as it’s a warning system for us, but we do want to find the right balance of pain relief and drug side effects,” added Gilron. “Morphine and nortriptyline are excellent candidates for pain management because of the extensive research conducted on them, their low cost, and widespread availability all over the world.”