dothiepin-hydrochloride and Pain

The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis (RA) is not clear.. Forty-eight female out-patients with RA, with depression and/or anxiety, were entered into a double-blind, placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [Hospital Anxiety and Depression (HAD) scale and Hamilton Rating Scale (HRS) for Depression], pain [visual analogue scale (VAS)] and disability [Health Assessment Questionnaire (HAQ)].. Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain (F(d.f. 1,39) =5.7, P=0.02). There were further interaction effects between treatment and time on pain (F(d. f. 3,117) =3.3, P=0.03), disability (F(d.f. 3,117)=4.2, P=0.008) and duration of early morning stiffness (F(d.f. 3,117) =3.3, P=0.03). Depression (HRS) was considerably reduced in both the dothiepin and placebo groups, and there was no significant difference between groups. Post hoc analyses using analysis of covariance revealed that, in the dothiepin group, pain was significantly reduced by week 4 and remained so at week 12. Disability scores and duration of early morning stiffness were consistently lower in the dothiepin group, although differences failed to reach statistical significance at any follow-up assessment. In the group as a whole, reductions in pain were highly significantly correlated with reductions in HAD depression (r =0.63, P<0.0005), HAD anxiety (r=0.46, P=0.001) and HRS depression (r=0.37, P=0.01).. Dothiepin is effective in relieving pain, disability and reducing the duration of early morning stiffness in out-patients with RA. Although there is a general association between pain reduction and improved anxiety and depression, the analgesic effect of dothiepin is independent of its antidepressant effect. Individual variation is considerable and further research should try to identify mechanisms of interaction between the antidepressant and analgesic effects of treatment in different patient groups.

Topics: Affect; Aged; Analgesia; Analysis of Variance; Antidepressive Agents, Tricyclic; Anxiety; Arthritis, Rheumatoid; Depression; Dothiepin; Double-Blind Method; Female; Humans; Middle Aged; Pain; Placebos

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Dibenzothiepins; Dothiepin; Double-Blind Method; Face; Humans; Middle Aged; Mouth Protectors; Pain; Pain Management; Placebos; Prognosis; Psychophysiologic Disorders

An account is given of a two-centre controlled clinical trial to assess the efficacy of dothiepin (Prothiaden) against placebo and a soft bite-guard in the treatment of psychogenic facial pain. The results confirm the superiority of the dothiepin to placebo in achieving pain relief, but show no benefit from the use of mechanical treatment. Short-term relapse of pain which occurred in the follow-up period was not associated with recurrence of psychiatric symptoms but appeared to be directly related to withdrawal of dothiepin.

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Dothiepin; Double-Blind Method; Face; Female; Humans; Male; Middle Aged; Pain; Psychophysiologic Disorders; Random Allocation; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome

Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Dothiepin; Facial Pain; Humans; Nervous System Diseases; Pain

In alloxan-diabetic rats of 4 wk duration with blood glucose levels of about 300 mg/100 ml, the tail flick reaction time (TFRT) to thermal stimuli was significantly elevated (P less than 0.25), indicating hypoalgesia. Intraperitoneal dothiepin, injections of 25 mg & 50 mg/kg body weight per day did not significantly alter the TFRT, either in control or in diabetic rats, following either acute (one dose), or short term (once a day for five days) administration. It is concluded that at least in the dosage schedule used herein, dothiepin does not influence hypoalgesia of diabetic neuropathy.

Topics: Analysis of Variance; Animals; Blood Glucose; Diabetes Mellitus, Experimental; Diabetic Neuropathies; Dothiepin; Female; Injections, Intraperitoneal; Male; Pain; Pain Measurement; Random Allocation; Rats; Rats, Inbred Strains

Topics: Animals; Brain; Brain Stem; Cerebral Cortex; Dibenzothiepins; Dothiepin; Fatty Acids, Nonesterified; Hypothalamus; Pain; Rats