Amitriptyline for Back Pain

Conclusions from a double-blind randomized clinical trial suggest that low-dose amitriptyline may be beneficial in the treatment of chronic low back pain. The study found that, although it did not significantly improve patients’ pain levels, use of the antidepressant did reduce disability, and without significant adverse effects. The trial was conducted by Donna Urquhart, PhD, and colleagues from the School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia. Dr. Urquhart wrote that “Antidepressants at low dose are commonly prescribed for the management of chronic low back pain and their use is recommended in international clinical guidelines. However, there is no evidence for their efficacy.” The findings were published in JAMA Internal Medicine.

In the trial, 146 subjects were randomly assigned to receive either 25 mg/day of amitriptyline or 1 mg/day of benztropine mesylate, an active comparator for 6 months. 80% of the test population completed the trial duration. The 2 cohorts did not exhibit significant differences in pain at either 3 months or 6 months. At 3 months, the amitriptyline group did show statistically significant improvements in disability levels, however. The authors concluded that “[The findings] provide support for large-scale clinical trials of low dose amitriptyline, with gradual dose escalation. In the meantime, it may be worth trying low-dose amitriptyline for these patients, especially if the only alternative is an opioid.”

Read about the findings.

The journal abstract may be read here.

Other Categories:

• chronic pain

• medication