A case of a chemically dependent patient with a thalamic pain syndrome treated with amitriptyline

A fifty year old white male with a right sided thalamic pain syndrome became alcohol and benzodiazepine dependent in an attempt to alleviate the pain. He entered an inpatient alcohol and drug treatment facility where, in an attempt to treat this pain, he was placed on low dose amitriptyline. Comparison of results on a symptoms checklist (SCL-90-R) completed at amitriptyline dosages of 30 mg. and 50 mg. showed a statistically significant difference in the somatization scale (p = .029). The low dose of amitriptyline used, its low blood level, and the early onset of effect make it unlikely that its antidepressant action was a significant factor in this patient's pain relief. This is, perhaps, the first described case where low dose amitriptyline has been shown to relieve the thalamic pain syndrome in a chemically dependent person.