This update has provided additional confirmation on the effectiveness of antidepressants for neuropathic pain and has provided new information on another antidepressant - venlafaxine. There is still limited evidence for the role of SSRIs. Whether antidepressants prevent the development of neuropathic pain (pre-emptive use) is still unclear. Both TCAs and venlafaxine have NNTs of approximately three. This means that for approximately every three patients with neuropathic pain who are treated with either of these antidepressants, one will get at least moderate pain relief. There is evidence to suggest that other antidepressants may be effective but numbers of participants are insufficient to calculate robust NNTs. SSRIs are generally better tolerated by patients and more high quality studies are required.
Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study.
To evaluate whether amitriptyline is more effective than placebo in improving phantom limb pain or residual limb pain.
                Randomized controlled trial of amitriptyline for 6 weeks.
                University hospital.
                Thirty-nine persons with amputation-related pain lasting more than 6 months.
                Six-week trial of amitriptyline (titrated up to 125 mg/d) or an active placebo (benztropine mesylate).
                Analyses were conducted to examine whether there was a medication group effect on the primary outcomes (average pain intensity) and secondary outcome measures (disability, satisfaction with life, handicap).
                No significant differences were found between the treatment groups in outcome variables when controlling for initial pain scores.
                Our findings do not support the use of amitriptyline in the treatment of postamputation pain.