AUTHORS: Maarrawi J et al
European Journal of Pain (Feb 2018)
BACKGROUND Amitriptyline has well-established efficacy in several chronic pain conditions. While optimal treatment for chronic neck pain (CNP) remains controversial, amitriptyline was not tested for CNP. We evaluated the effect of bedtime amitriptyline in the management of CNP.
METHODS 220 patients suffering from idiopathic CNP were randomized to receive either placebo pill (n = 108) or 5 mg of amitriptyline (n = 112) at bedtime for two months. Primary outcome measure was visual analog scale (VAS) for pain. Secondary outcome measures were Neck pain Disability Index (NPDI), Bergen Insomnia Score (BIS), and Hospital Anxiety and Depression Scale (HAD), measured before and at the end of two months of treatment, with the percentage of patient satisfaction measured at the end of follow-up only.
RESULTS 8/112 patients (7.14%) in the amitriptyline group withdrew from the study because of intolerance. Amitriptyline group showed significantly lower VAS scores than placebo group (3.34 ± 1.45 versus 6.12 ± 0.92; p < 0.0001), which corresponds to a 53.06 ± 20.29% of improvement from baseline pain as compared to 14.41 ± 11.05%, respectively (p < 0.0001). Similar significant improvements were observed with lesser extents for secondary outcome measures: NPDI, BIS, HAD-A, HAD-D and percentage of patient satisfaction.
CONCLUSION Low-dose amitriptyline is effective for the management of idiopathic CNP with few side effects and high patients’ satisfaction