During the last millenium, mankind made revolutionary advances in relieving pain. Treatment progressed from non-treatments, such as "biting the bullet," to alcohol and crude opium-based drugs, to the development of safe modern opioids, or narcotic-based painkillers, and a wide range of general and local anesthetics. At least in the developed world, most everyone has found pain relief, at one time or another, from one of these drugs.

Yet despite all our advances, there is one type of pain which, until recently, could not effectively be controlled by modern medicine — neuropathic pain.

Usually chronic and often devastating, neuropathic pain is the result of damage to the body's nervous system. The two most common causes are diabetes ("diabetic neuropathy") and herpes zoster ("postherpetic neuralgia" or "shingles"), an infection of the nerves by the same virus that causes chickenpox. Both cause excruciating pain.

Frequently, there is a long delay between the actual nerve injury and the appearance of pain; in fact, it is not unusual for the pain to begin at about the time a person is beginning to recover physically.

Desipramine, another TCA, appears to be almost as effective as amitriptyline in most studies,(13)(15) but with fewer side effects and significantly less drowsiness.