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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Both the incidence and the severity of herpes zoster increase with advancing age. Postherpetic neuralgia may persist for more than a year. Treatment is usually symptomatic, and early corticosteroid therapy should be considered in patients over age 50. Psychotropic drugs also may be indicated to overcome depression.
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PMID:Herpes zoster: a geriatric disease. 46 81

Amitriptyline (AT) relieves some patients with postherpetic neuralgia (PHN). Many patients suffer side effects and better therapies are necessary. The aim of this study was to evaluate the efficacy of maprotiline (MT) (noradrenergic) compared to AT (mixed noradrenergic and serotonergic) in this disorder. Thirty-five patients entered a randomized, double-blind, crossover trial of these two agents. We found that MT relieved PHN in many patients but was not as effective as AT. Side effects were troublesome with both agents. Relief of steady pain, brief pain and pain on tactile stimulation occurred. Four groups of responses were identified. Some patients reported relief with both agents, some with neither agent and others with only one of the drugs. Most patients were not depressed and analgesia was observed to occur without change in depression ratings in most patients who responded. This result provides evidence that in some patients AT may act via a selective noradrenergic mechanism in relieving PHN and that individuals may differ in the balance and type of neurotransmitters inhibiting pain. Selective noradrenergic agents may be effective if AT fails.
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PMID:Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial. 173 71

Conditions in which antidepressants have been used include diabetic neuropathy, postherpetic neuralgia, headaches, arthritis, chronic back pain, cancer, thalamic pain, facial pain, and phantom limb pain. Although much of the available information is derived from inadequately controlled trials, it seems that antidepressants provide analgesia in many of these disorders. The analgesic effects tend to be independent of antidepressant effects, and doses of heterocyclic antidepressants used for analgesia seem to be lower than those considered effective in the treatment of depression. Doses should be started low and gradually increased until the patient reaches the highest tolerable dose. Onset of analgesia is variable, ranging from 1 day to 10 weeks. Common side effects include dry mouth, drowsiness, urinary retention, orthostatic hypotension, and constipation. Optimum dosages and schedules have not been established.
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PMID:Antidepressants in the management of chronic pain syndromes. 214 20

Desipramine has the least anticholinergic and sedative effects of the first generation tricyclic antidepressant agents, but its pain-relieving potential has received little study. Other antidepressant agents--notably amitriptyline--are known to ameliorate postherpetic neuralgia, but those agents are often toxic. In a randomized double-blind crossover design, we gave 26 postherpetic neuralgia patients 6 weeks of treatment with desipramine (mean dose, 167 mg/day) and placebo. Nineteen patients completed both treatments; 12 reported at least moderate relief with desipramine and two reported relief with placebo. Pain relief with desipramine was statistically significant from weeks 3 to 6. Psychiatric interview at entry into the study produced a diagnosis of depression for 4 patients; pain relief was similar in depressed and nondepressed patients and was statistically significant in the nondepressed group alone. We conclude that desipramine administration relieves postherpetic neuralgia and that pain relief is not mediated by mood elevation. Blockade of norepinephrine reuptake, an action shared by desipramine, amitriptyline, and other antidepressant agents that have relieved neuropathic pain, may be involved in relief of postherpetic neuralgia.
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PMID:Desipramine relieves postherpetic neuralgia. 217 51

Pain is both a sensory and an emotional experience. In a multidisciplinary pain management clinic for a geriatric population, pain and mood have been assessed prior to the initiation of management in 49 of 100 referred patients. Patients have been assessed clinically, for psychological disability using the profile of mood states (POMS) and a visual analogue scale for mood, for pain using the McGill pain questionnaire (short form), word descriptor scale and visual analogue scale and for activities of daily living (ADL) using the Disability and Impairment Interview Schedule and the Rapid Disability Rating Scale -2. All testing has followed initial screening to exclude dementia. For the group assessed by psychometric measures, median age was 75 years (range 56 to 91); 41 were female. Major pathologies were degenerative musculoskeletal disease (15), post-herpetic neuralgia (9), and psychiatric conditions (7). Intra-test item correlations were found to be significant for the McGill questionnaire and the POMS. Inter-test correlations were observed for pain measures (McGill present pain intensity with VAS pain, r = 0.67; with word descriptor, 0.64; p less than 0.001), for ADL measures (r = 0.53, p less than 0.001) and for measures of mood (VAS mood with POMS (depression), r = 0.45; p less than 0.001; with POMS (anxiety), r = 0.35; p less than 0.01. There was no significant correlation between measures of mood and pain on the McGill scale. The data to this time support the view that standard psychometric tools can be used reliably to evaluate pain, mood and activity in this population. Furthermore, it appears that mood and pain may be measured separately.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Can psychometric tools be used to analyse pain in a geriatric population? 264 22

Serotoninergic pathways are believed to be important in pain mechanisms. Accordingly, we studied the action of zimelidine, a very highly serotoninergic antidepressant, in relieving the pain of post-herpetic neuralgia. Fifteen patients received zimelidine and amitriptyline in that order in an open-label cross-over study. Only one patient with zimelidine obtained a good result, whereas 8 patients on amitriptyline amitriptyline has a pain-relieving action, at least in post-herpetic neuralgia, which is not primarily linked with its serotoninergic effects and which is also independent of its effects on depression.
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PMID:A comparative trial of amitriptyline and zimelidine in post-herpetic neuralgia. 293 72

Antidepressant drugs have been used successfully in the treatment of chronic pain syndromes. Clinical trials have supported the use of these drugs for pain and the depression that often accompanies pain syndromes. Although the exact mechanisms of action have not been clearly elucidated, it has been suggested that these agents have analgesic properties independent of their antidepressant effect on mood and behavior. Pain patients without concomitant depression experienced pain relief with antidepressant therapy; these patients represent the most convincing evidence that antidepressant drugs have a direct analgesic effect. Studies presented in this paper support the clinical efficacy of antidepressant medications in the treatment of patients suffering from headaches (migraine, tension, and mixed types), diabetic neuropathy, arthritis, and facial pain. These data also suggest that antidepressant drugs may be effective in the treatment of postherpetic neuralgia, back pain, and pain from mixed etiologies; however, data for these pain syndromes are less clear, and, thus, further testing is required.
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PMID:The future for antidepressants: treatment of pain. 332 Nov 36

Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. There must be a careful psychosocial evaluation, for the majority of patients who come to the doctor complaining of pain have major psychological, social, or behavioral factors that are most important in the genesis of the complaint. Drug abuse must be corrected. Related symptoms, such as anxiety and depression, must be treated. Then, a thorough trail of transcutaneous stimulation is mandatory. A desultory use will undoubtedly lead to failure. This trial must begin with patient education by experienced personnel. Then the electrodes must be properly applied, and there must be a regular follow-up of stimulation to be certain the patient is utilizing it correctly. The patient must be supported through an adequate trial which should extend over 2-4 weeks before purchase of the device is contemplated. Furthermore, all related nursing and physician personnel must be educated in the proper use of the technique. The uninformed professional who denigrates the therapy is a very effective deterrent to appropriate use. In this situation, transcutaneous electrical stimulation will be of great value in the treatment of acute musculoskeletal injury and acute postoperative pain. It will be effective in the treatment of peripheral nerve injury pain, chronic musculoskeletal abnormalities, chronic pain in the patient who has undergone multiple operations upon the low back and neck, visceral pain, some of the reflex sympathetic dystrophies, and postherpetic neuralgia. Stimulation will not help a complaint which is psychosomatic in origin. It will not influence drug addiction. It is not likely to be useful in any situation where secondary gain is important. The metabolic neuropathies, pain of spinal cord injury, and pain from cerebrovascular accident will not respond frequently enough to warrant more than hopeful trials. The technique is inexpensive, places the patient in control of his own pain, and has no known serious side effects. Its widespread application awaits the development of reasonable systems to provide this service to physicians and patients. Stimulation-induced analgesia deserves a place in the armamentarium of every physician dealing with the complaint of pain.
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PMID:Stimulation of the peripheral nervous system for pain control. 623 44

This presentation will briefly describe the operation of this Pain Center and discuss the two chronic pain problems most commonly seen in our geriatric population: osteoarthritis of the spine and herpetic neuralgia. Osteoarthritis of the spine is the most common radiologic finding in middle-aged and older people with low back pain. 32% of our patients have this diagnosis as the basis of their chronic pain. The typical patient is 72 years old and has a past pain history which includes several years of back pain treated by various physicians with anti-inflammatory agents and analgesics to no avail. Past history of surgery and drug abuse is rare; however, depression is common. Therapy at the Pain Center is primarily the use of an exercise program and epidural and/or subarachnoid steroids. At the last visit, approximately 70% of the patients have had significant improvement. Herpetic neuralgia is found in 13% of all patients seen at the Mount Sinai Medical Center Pain Center. Our typical patient is 73 years old and has had PHN for 10 months unrelieved by various topical and oral medications. Although rarely is there a history of drug abuse or surgery, extreme depression is common. If the duration of the neuralgia is less than one year, 85% of patients get significant or complete relief from the use of sympathetic nerve blocks and/or the subcutaneous infiltration of steroids and local anesthetic. Once the PHN has been present for more than one year, only 55% of the patients are improved.
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PMID:Treatment of osteoarthritis of the spine and herpetic neuralgia at the Pain Center, Mount Sinai Medical Center. 626 70

Home parenteral nutrition (HPN) for the short bowel syndrome represents a treatment modality that raises issues about prolonged machine dependency for living. Psychological reactions are described for patients with inflammatory bowel disorders and anatomical loss of small bowel. Liaison psychiatry involvement with 50 patients in the HPN program has identified such problems as grief reactions, depression, organic brain syndromes, drug dependency, and body image changes as they influence the initial adjustment to the in-hospital phase of HPN learning for patient and family. The importance of family and mental status examination are emphasized in the evaluation of the patient before and during the institution of an PHN program. Outlined are psychological parameters that need to be considered when assessing what factors might impede or enhance the acquisition and use of HPN information.
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PMID:Home parenteral nutrition for the short bowel syndrome. Psychological issues. 678 Apr 8


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