Easing the pain: combination of nortriptyline and morphine may provide better relief than either drug alone, new study says

The combination of two well-known drugs could have unprecedented effects on pain management, says new research published in Pain.
Using morphine (a narcotic pain reliever) with nortriptyline (an antidepressant) has been found to successfully relieve chronic neuropathic pain in 87% of patients studied, and significantly better than with either drug alone.
“Chronic pain is an increasingly common problem and can exert disastrous personal, societal, and socio-economic impacts on patients, their families, and their communities,” explains Prof Ian Gilron, lead author. “Current neuropathic pain treatments are ineffective or intolerable for many sufferers so this new evidence supporting the morphine-nortriptyline combination is important news.”
During the study, average daily pain was measured using a scale from 0–10. Every patient had the opportunity to try each of the three treatment plans in each of the three six-week treatment periods: the combination; morphine alone; and nortriptyline alone. Throughout each treatment period, patients attended follow-up assessments to record their pain levels and side effects.
It was found that average daily pain before treatment was 5.6, which dropped to 2.6 when patients were receiving the drug combination. On average, patients taking nortriptyline and morphine alone rated their pain at 3.1 and 3.4, respectively.
Common side effects for both drugs, which can include constipation and dry mouth, did not worsen during the 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,” says Prof 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.”

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Image credit: Image credit: Petras Gagilas