Editing Tricyclic antidepressant (section)

=== Chronic pain ===
The TCAs show efficacy in the clinical treatment of a number of different types of [[chronic pain]], notably neuralgia or [[neuropathic pain]] and [[fibromyalgia]].<ref name="pmid16762426">{{cite journal | vauthors=Micó JA, Ardid D, Berrocoso E, Eschalier A | title=Antidepressants and pain | journal=Trends in Pharmacological Sciences | volume=27 | issue=7 | pages=348–354 | date=July 2006 | pmid=16762426 | doi=10.1016/j.tips.2006.05.004}}</ref><ref name="pmid9121808">{{cite journal | vauthors=McQuay HJ, Tramèr M, Nye BA, Carroll D, Wiffen PJ, Moore RA | title=A systematic review of antidepressants in neuropathic pain | journal=Pain | volume=68 | issue=2–3 | pages=217–227 | date=December 1996 | pmid=9121808 | doi=10.1016/S0304-3959(96)03140-5 | s2cid=25124663}}</ref> The precise [[mechanism of action]] in explanation of their analgesic efficacy is unclear, but it is thought that they indirectly modulate the [[opioid]] system in the brain downstream via [[Serotonin|serotonergic]] and [[noradrenergic]] [[Neuromodulation (biology)|neuromodulation]], among other properties.<ref name="pmid6219612">{{cite journal | vauthors=Botney M, Fields HL | title=Amitriptyline potentiates morphine analgesia by a direct action on the central nervous system | journal=Annals of Neurology | volume=13 | issue=2 | pages=160–164 | date=February 1983 | pmid=6219612 | doi=10.1002/ana.410130209 | s2cid=40631429}}</ref><ref>{{cite journal | vauthors=Benbouzid M, Gavériaux-Ruff C, Yalcin I, Waltisperger E, Tessier LH, Muller A, Kieffer BL, Freund-Mercier MJ, Barrot M | display-authors=6 | title=Delta-opioid receptors are critical for tricyclic antidepressant treatment of neuropathic allodynia | journal=Biological Psychiatry | volume=63 | issue=6 | pages=633–636 | date=March 2008 | pmid=17693391 | doi=10.1016/j.biopsych.2007.06.016 | s2cid=22957748}}</ref><ref>{{cite journal | vauthors=de Gandarias JM, Echevarria E, Acebes I, Silio M, Casis L | title=Effects of imipramine administration on mu-opioid receptor immunostaining in the rat forebrain | journal=Arzneimittel-Forschung | volume=48 | issue=7 | pages=717–719 | date=July 1998 | pmid=9706370}}</ref> They are also effective in [[migraine]] [[prophylaxis]],<ref>{{cite journal | last1=Jackson | first1=J. L. | title=Tricyclic antidepressants and headaches: systematic review and meta-analysis | journal=BMJ | volume=341 | pages=c5222 | year=2010 | pmid=20961988 | pmc=2958257 | doi=10.1136/bmj.c5222 | last2=Shimeall | first2=W. | last3=Sessums | first3=L. | display-authors=3 | last4=Dezee | first4=K. J. | last5=Becher | first5=D. | last6=Diemer | first6=M. | last7=Berbano | first7=E. | last8=O'Malley | first8=P. G.}}</ref> though not in the instant relief of an acute migraine attack. They may also be effective to prevent chronic tension headaches.