Randomized double‐blind controlled study of bedtime low‐dose amitriptyline in chronic neck pain

Maarrawi, Joseph; Hay, Joe Abdel; Kobaïter-Maarrawi, Sandra; Tabet, Patrick; Peyron, R.; Garcia-Larrea, Luis

doi:10.1002/ejp.1206

Cited by 16 publications

(14 citation statements)

References 30 publications

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“…A post hoc sensitivity analysis explored the effect of removing one trial from the pooled estimates for back pain 59. The participants in this trial had neck pain, received a dose of amitriptyline (5 mg/day) lower than the minimum dose recommended for pain relief (10-25 mg/day), and reported unexpectedly large improvements in pain and disability compared with other studies.…”

Section: Resultsmentioning

confidence: 99%

“…Large, definitive trials free of industry ties are urgently needed to evaluate the efficacy of antidepressants. In our review, all but one trial59 with sample sizes of more than 100 participants in each group were sponsored by industry. New trials will be particularly relevant when testing the efficacy of TCAs and SNRIs in people with sciatica, where clinically important benefits might exist; and in osteoarthritis, where clinically important benefits cannot be excluded but most of the data come from industry sponsored trials 484950515258…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Ferreira

McLachlan

Lin

et al. 2021

BMJ

102

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Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020. Eligibility criteria for study selection Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis. Data extraction and synthesis Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework. Results 33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (−7.55, −18.25 to 3.15) but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (−3.55, −5.22 to −1.88) and disability due to osteoarthritis at two weeks or less (−5.10, −7.31 to −2.89), with low certainty evidence at 3-13 weeks (−6.07, −8.13 to −4.02). TCAs and other antidepressants did not reduce pain or disability from back pain. Conclusion Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low. Systematic review registration PROSPERO CRD42020158521.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Ferreira

McLachlan

Lin

et al. 2021

BMJ

102

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“…Because of worse tolerability, the doses of amitriptyline used in painful patients are classically initiated at 5–10 mg/day (e.g. Maarrawi et al., ) and are lower than those used for depressed patients (starting dose = 50–75 mg/day). These arguments should be taken into consideration for future trials.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a T‐type calcium channel blocker in patients with neuropathic pain: A proof‐of‐concept, randomized, double‐blind and controlled trial

Kerckhove

Pereira

Soriot-Thomas

et al. 2018

European Journal of Pain

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“…Among available and established pharmacological treat ments, antidepressants are effective in different chronic musculoskeletal pain conditions associated with central sensitisation, such as fibromyalgia, 81 low back pain, 82 neck pain, 83 and knee osteoarthritis. 84 A syste matic review found moderate to high quality evidence that the anti convulsant gabapentin is ineffective for the treatment of low back pain or lumbar radicular pain, 85 whereas another systematic review found insuffi cient evidence to either support or refute the efficacy of gabapentin in reducing pain in patients with fibromyalgia.…”

Section: Can Central Sensitisation Be Treated In Patients With Chronimentioning

confidence: 99%

Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

Nijs

George

Clauw

et al. 2021

The Lancet Rheumatology

228

181

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Chronic pain is a leading cause of disability globally and associated with enormous health-care costs. The discrepancy between the extent of tissue damage and the magnitude of pain, disability, and associated symptoms represents a diagnostic challenge for rheumatology specialists. Central sensitisation, defined as an amplification of neural signalling within the CNS that elicits pain hypersensitivity, has been investigated as a reason for this discrepancy. Features of central sensitisation have been documented in various pain conditions common in rheumatology practice, including fibromyalgia, osteoarthritis, rheumatoid arthritis, Ehlers-Danlos syndrome, upper extremity tendinopathies, headache, and spinal pain. Within individual pain conditions, there is substantial variation among patients in terms of presence and magnitude of central sensitisation, stressing the importance of individual assessment. Central sensitisation predicts poor treatment outcomes in multiple patient populations. The available evidence supports various pharmacological and non-pharmacological strategies to reduce central sensitisation and to improve patient outcomes in several conditions commonly seen in rheumatology practice. These data open up new treatment perspectives, with the possibility for precision pain medicine treatment according to pain phenotyping as a logical next step. With this view, studies suggest the possibility of matching non-pharmacological approaches, or medications, or both to the central sensitisation pain phenotypes.

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Randomized double‐blind controlled study of bedtime low‐dose amitriptyline in chronic neck pain

Cited by 16 publications

References 30 publications

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

Efficacy and safety of a T‐type calcium channel blocker in patients with neuropathic pain: A proof‐of‐concept, randomized, double‐blind and controlled trial

Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

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