Abstract：
OBJECTIVE: This study aims to quantitatively analyse nortriptyline\'s analgesic potency, safety and tolerability.
METHODS: Systematic review and meta-analysis.
METHODS: The systematic search was conducted in Scopus, Web of Science and PubMed in February 2023.
METHODS: Clinical trials evaluating the efficacy of nortriptyline in reducing pain scores (open-label studies and comparisons of nortriptyline with placebo or other analgesics) in different pain types were included.
METHODS: The data extraction procedure and the screening phases were carried out based on predetermined eligibility criteria. To pool the data, the standardised mean difference (SMD) and standardised mean change (SMC) methods, along with random-effect and fixed-effect meta-analysis, were used. The risk of bias was assessed using the Cochrane Collaboration method, and the Grading of Recommendations Assessment, Development and Evaluation criteria were used to measure the certainty of the results.
RESULTS: 14 of the initial 648 studies were eventually imported. Nortriptyline was reported to significantly reduce pain severity in chronic low back pain, painful symptoms in major depressive disorder, neuropathy, chronic pelvic pain and neuropathic corneal pain. However, it was not superior to placebo in fibromyalgia and knee osteoarthritis. In comparison to placebo and various alternative analgesics, the pooled SMD for lowering pain scores was 0.43 (0.23-0.64) and -0.18 (-0.39 to 0.03), respectively. In the pretreatment and post-treatment analyses, the pooled SMC was -1.20 (-1.48 to -0.93). Although constipation and xerostomia were the most commonly reported side effects, all references indicated that the adverse events were well tolerated at the administered dosages.
CONCLUSIONS: While nortriptyline is effective in some chronic pains, such as neuropathies, it lacks efficacy in some other chronic pains, such as fibromyalgia and osteoarthritis. Nortriptyline is well tolerated when administered in doses intended for its analgesic effects. Moreover, several studies suggested that the analgesic effects of nortriptyline are comparable to those of amitriptyline and gabapentin.
METHODS: Systematic review and meta-analysis.
METHODS: The systematic search was conducted in Scopus, Web of Science and PubMed in February 2023.
METHODS: Clinical trials evaluating the efficacy of nortriptyline in reducing pain scores (open-label studies and comparisons of nortriptyline with placebo or other analgesics) in different pain types were included.
METHODS: The data extraction procedure and the screening phases were carried out based on predetermined eligibility criteria. To pool the data, the standardised mean difference (SMD) and standardised mean change (SMC) methods, along with random-effect and fixed-effect meta-analysis, were used. The risk of bias was assessed using the Cochrane Collaboration method, and the Grading of Recommendations Assessment, Development and Evaluation criteria were used to measure the certainty of the results.
RESULTS: 14 of the initial 648 studies were eventually imported. Nortriptyline was reported to significantly reduce pain severity in chronic low back pain, painful symptoms in major depressive disorder, neuropathy, chronic pelvic pain and neuropathic corneal pain. However, it was not superior to placebo in fibromyalgia and knee osteoarthritis. In comparison to placebo and various alternative analgesics, the pooled SMD for lowering pain scores was 0.43 (0.23-0.64) and -0.18 (-0.39 to 0.03), respectively. In the pretreatment and post-treatment analyses, the pooled SMC was -1.20 (-1.48 to -0.93). Although constipation and xerostomia were the most commonly reported side effects, all references indicated that the adverse events were well tolerated at the administered dosages.
CONCLUSIONS: While nortriptyline is effective in some chronic pains, such as neuropathies, it lacks efficacy in some other chronic pains, such as fibromyalgia and osteoarthritis. Nortriptyline is well tolerated when administered in doses intended for its analgesic effects. Moreover, several studies suggested that the analgesic effects of nortriptyline are comparable to those of amitriptyline and gabapentin.
摘要：
目的：本研究旨在定量分析去甲替林的镇痛效力，安全性和耐受性。
方法：系统评价和荟萃分析。
方法：在Scopus进行了系统搜索，2023年2月，WebofScience和PubMed。
方法：纳入了评价去甲替林在不同疼痛类型中降低疼痛评分的疗效的临床试验（开放标签研究以及去甲替林与安慰剂或其他镇痛药的比较）。
方法：根据预定的合格标准进行数据提取程序和筛选阶段。要汇集数据，标准化平均差(SMD)和标准化均值变化(SMC)方法，以及随机效应和固定效应荟萃分析，被使用。使用Cochrane协作方法评估偏倚风险，和建议评估的分级，使用开发和评估标准来测量结果的确定性。
结果：最初的648项研究中有14项最终被导入。据报道，Nortriptyline可显着降低慢性下腰痛的疼痛严重程度。重度抑郁症的痛苦症状，神经病,慢性盆腔疼痛和神经性角膜疼痛。然而,在纤维肌痛和膝骨关节炎方面，它并不优于安慰剂。与安慰剂和各种替代镇痛药相比，降低疼痛评分的合并SMD为0.43（0.23-0.64）和-0.18（-0.39-0.03），分别。在预处理和后处理分析中，合并的SMC为-1.20（-1.48至-0.93）。尽管便秘和口干症是最常见的副作用，所有参考文献均表明,在给药剂量下,不良事件的耐受性良好.
结论：虽然去甲替林对某些慢性疼痛有效，比如神经病,它在其他一些慢性疼痛中缺乏疗效，如纤维肌痛和骨关节炎。当以旨在其镇痛作用的剂量给药时，诺曲替林具有良好的耐受性。此外，一些研究表明，去甲替林的镇痛效果与阿米替林和加巴喷丁相当。
方法：系统评价和荟萃分析。
方法：在Scopus进行了系统搜索，2023年2月，WebofScience和PubMed。
方法：纳入了评价去甲替林在不同疼痛类型中降低疼痛评分的疗效的临床试验（开放标签研究以及去甲替林与安慰剂或其他镇痛药的比较）。
方法：根据预定的合格标准进行数据提取程序和筛选阶段。要汇集数据，标准化平均差(SMD)和标准化均值变化(SMC)方法，以及随机效应和固定效应荟萃分析，被使用。使用Cochrane协作方法评估偏倚风险，和建议评估的分级，使用开发和评估标准来测量结果的确定性。
结果：最初的648项研究中有14项最终被导入。据报道，Nortriptyline可显着降低慢性下腰痛的疼痛严重程度。重度抑郁症的痛苦症状，神经病,慢性盆腔疼痛和神经性角膜疼痛。然而,在纤维肌痛和膝骨关节炎方面，它并不优于安慰剂。与安慰剂和各种替代镇痛药相比，降低疼痛评分的合并SMD为0.43（0.23-0.64）和-0.18（-0.39-0.03），分别。在预处理和后处理分析中，合并的SMC为-1.20（-1.48至-0.93）。尽管便秘和口干症是最常见的副作用，所有参考文献均表明,在给药剂量下,不良事件的耐受性良好.
结论：虽然去甲替林对某些慢性疼痛有效，比如神经病,它在其他一些慢性疼痛中缺乏疗效，如纤维肌痛和骨关节炎。当以旨在其镇痛作用的剂量给药时，诺曲替林具有良好的耐受性。此外，一些研究表明，去甲替林的镇痛效果与阿米替林和加巴喷丁相当。
