Amitriptyline for musculoskeletal complaints: a systematic review

Driest, Jacoline J van den; Bierma-Zeinstra, Sita M A; Bindels, Patrick J E; Schiphof, D.

doi:10.1093/fampra/cmw134

Cited by 17 publications

(10 citation statements)

References 41 publications

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“…Those ADRs are linked with TCAs mechanism in muscarinic cholinergic receptors [12,31]. The result of our study is in line with some systematic reviews [30,32,33]. A systematic review suggests strong evidence regarding dry mouth and constipation as ADRs of amitriptyline and desipramine, also constipation, insomnia, and drowsiness as ADRs of nortriptyline [32].…”

Section: Discussionsupporting

confidence: 90%

Tricyclic Antidepressants in Chronic Low Back Pain : A Review

Ilmanita

Hidayati

2020

J. Islamic Pharm.

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Chronic low back pain (LBP) is the frequent chronic pain and notable health problem which is the main reason of disabling conditions, individual suffering, sick leave, and costly treatment. Unfortunately, available therapy especially oral medicines only beneficial in no more than 50% of patients. Tricyclic antidepressants (TCAs) are commonly used for neuropathic pain but the data for neuropathic LBP is limited. The purpose of this review is to evaluate the efficacy and adverse drug reaction of TCAs in chronic LBP. We searched scientific search engines including Scopus and PubMed and collected original articles including Randomized Clinical Trial (RCT), comparative, and observational study about Tricyclic Antidepressants treatment in chronic LBP from 1998 to 2019. In this review, 5 articles and 543 patients were evaluated. All recruited articles are randomized clinical trials. Among all five relevant articles, three of them evaluate amitriptyline treatment in chronic LBP while the rest articles evaluate imipramine and nortriptyline. Amitriptyline is the most well-studied TCA for chronic LBP. We found that both amitriptyline and nortriptyline can reduce pain severity significantly when the dose is increased gradually depending on patient tolerance. TCAs can also improve disability significantly. However, single-dose imipramine is not superior than placebo. We conclude that TCAs can be effective for treating chronic LBP when used routinely for several weeks and the dose should be increased gradually depending on patient tolerance although further studies are required to confirm the optimal dose for analgesia. The most prevalence Adverse Drug Reactions (ADRs) of TCA including dry mouth, somnolence, insomnia, sedation, and constipation.

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Section: Discussionsupporting

confidence: 90%

Tricyclic Antidepressants in Chronic Low Back Pain : A Review

Ilmanita

Hidayati

2020

J. Islamic Pharm.

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“…Clinical evidence suggests that dual antidepressants provide better analgesic efficacy in chronic neuropathic pain. In this regard, the analgesic efficacy of amitriptyline (a tricyclic antidepressant -TCA) is the bestdocumented in complex regional pain syndrome, neuropathic and musculoskeletal pain, and fibromyalgia (Wiffen et al, 2013;Moore et al, 2015;Brown et al, 2016;van den Driest et al, 2017). However, due to the side effects of TCAs, the SNRI duloxetine has been the first choice treatment for peripheral diabetic neuropathic pain and fibromyalgia, with a good safety profile.…”

Section: Clinical Approachmentioning

confidence: 99%

Monoamines as Drug Targets in Chronic Pain: Focusing on Neuropathic Pain

et al. 2019

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Monoamines are involved in regulating the endogenous pain system and indeed, peripheral and central monoaminergic dysfunction has been demonstrated in certain types of pain, particularly in neuropathic pain. Accordingly, drugs that modulate the monaminergic system and that were originally designed to treat depression are now considered to be first line treatments for certain types of neuropathic pain (e.g., serotonin and noradrenaline (and also dopamine) reuptake inhibitors). The analgesia induced by these drugs seems to be mediated by inhibiting the reuptake of these monoamines, thereby reinforcing the descending inhibitory pain pathways. Hence, it is of particular interest to study the monoaminergic mechanisms involved in the development and maintenance of chronic pain. Other analgesic drugs may also be used in combination with monoamines to facilitate descending pain inhibition (e.g., gabapentinoids and opioids) and such combinations are often also used to alleviate certain types of chronic pain. By contrast, while NSAIDs are thought to influence the monoaminergic system, they just produce consistent analgesia in inflammatory pain. Thus, in this review we will provide preclinical and clinical evidence of the role of monoamines in the modulation of chronic pain, reviewing how this system is implicated in the analgesic mechanism of action of antidepressants, gabapentinoids, atypical opioids, NSAIDs and histaminergic drugs.

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“…The assessments of the methodological quality are given in Tables 2 and 3. Out of 25 included studies, 11, 9 and 5 studies were classified as high [2,14,16,17,33,34,37,41,44,45,48] moderate [12,35,36,42,43,47,49] and low [32,[38][39][40]46] quality, respectively. Table 3 shows the results of the methodological quality assessment according to each item.…”

Section: Assessment Of Methodological Quality Of Included Srsmentioning

confidence: 99%

“…Most SRs and MAs in this area, illustrated that there was no clear evidence of ADs effectiveness on LPB [2,16,34,41,[54][55][56] while others achieved contradictory results [18,35,36,57,58]. Some of them showed that TCAs had significant analgesic effect more than other types of Ads [15,17,32,40,42,[59][60][61][62], while there exists contradiction as well [63]. In addition, some reviews reported a lack of sufficient data for the conclusion [33,55,64].…”

Section: Summary Of Ads Effect On Lbpmentioning

confidence: 99%

“…There is conflicting evidence about the effect of antidepressant, different studies showed their beneficial role in pain reduction while others have opposed them due to the high risk of adverse effects such as dry mouth, dizziness, nausea, headache, and constipation and no clear evidence of efficacy [10][11][12][13]. In addition, some systematic reviews (SRs) and meta-analyses (MAs) which summarized the results of the available evidence, provided heterogeneous results which make it difficult to decision regarding the efficacy of ADs [14][15][16][17][18]. An SR is a type of literature review which critically evaluates research studies.…”

Section: Introductionmentioning

confidence: 99%

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A methodological quality assessment of systematic reviews and meta-analyses of antidepressants effect on low back pain using updated AMSTAR

Panahi

Mohseni

Tehrani

2020

BMC Med Res Methodol

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Background: Antidepressants are prescribed widely to manage low back pain. There are a number of systematic reviews and meta-analyses which have investigated the efficacy of the treatments, while the methodological quality of them has not been assessed yet. This study aims to evaluate the methodological quality of the systematic reviews and meta-analyses investigating the effect of antidepressants on low back pain. Methods: A systematic search was conducted in PubMed, EMBASE, Medline, and Cochrane Library databases up to November 2018. The 16-item Assessment of Multiple Systematic Reviews (AMSTAR2) scale was used to assess the methodological quality of the studies. Systematic reviews and meta-analyses of the Antidepressants treatment effects on low back pain published in English language were included. There was no limitation on the type of Antidepressants drugs, clinical setting, and study population, while non-systematical reviews and qualitative and narrative reviews were excluded. Results: A total of 25 systematic reviews and meta-analyses were evaluated; the studies were reported between 1992 and 2017. Obtained results from AMSTAR2 showed that 11 (44%), 9 (36%) and 5 (20%) of the included studies had high, moderate and low qualities, respectively. 13(52%) of studies assessed risk of bias and 2(20%) of meta analyses considered publication bias. Also, 16 (64%) of the included reviews provided a satisfactory explanation for any heterogeneity observed in the results. Conclusions: Although the trend of publishing high quality papers in ADs effect on LBP increased recently, performing more high-quality SRs and MAs in this field with precise subgroups of the type of pains, the class of drugs and their dosages may give clear and more reliable evidence to help clinicians and policymakers.

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Amitriptyline for musculoskeletal complaints: a systematic review

Abstract: Few studies have evaluated the use of amitriptyline in musculoskeletal complaints. Although amitriptyline may be effective in musculoskeletal complaints, more studies are required to establish for whom amitriptyline works better than other analgesics.

Cited by 17 publications

References 41 publications

Tricyclic Antidepressants in Chronic Low Back Pain : A Review

Tricyclic Antidepressants in Chronic Low Back Pain : A Review

Monoamines as Drug Targets in Chronic Pain: Focusing on Neuropathic Pain

A methodological quality assessment of systematic reviews and meta-analyses of antidepressants effect on low back pain using updated AMSTAR

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