Low-Dose amitriptyline effective in Chronic Low Back Pain

A new study of its kind published in JAMA Internal Medicine has found that low-dose antidepressant-amitriptyline- may be an effective treatment for chronic low back pain.

Donna M. Urquhart et al. conducted a double-blind, randomized clinical trial to examine the efficacy of a low-dose antidepressant compared with an active comparator in reducing pain, disability, and work absence and hindrance in the individuals with chronic low back pain.

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The study participants were randomly assigned with low-dose amitriptyline (25 mg/d) or an active comparator (benztropine mesylate, 1 mg/d) for 6 months. Of the 146 randomized participants, 118 (81%) completed the 6-month follow-up.

Key study findings:

• Treatment with low-dose amitriptyline did not result in greater pain reduction than the comparator at 6 or 3 months independent of baseline pain.


• There was no statistically significant difference in the disability between the groups at 6 months.


• However, there was a statistically significant improvement in disability for the low-dose amitriptyline group at 3 months.


• There were no differences between the groups in work outcomes at 6 months or 3 months.

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The study concluded that amitriptyline may be an effective treatment for chronic low back pain. Though there were no significant improvements in outcomes at 6 months, there was a reduction in disability at 3 months.

The authors warrant the need for large-scale clinical trials that include dose escalation but suggest that it may be worth considering low-dose amitriptyline if the only alternative is an opioid.

Pain in the low back can be a result of conditions affecting the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

For reference log on to 10.1001/jamainternmed.2018.4222