The effectiveness of tricyclic antidepressants on lumbar spinal stenosis

Tricyclic antidepressants have not been explicitly studied in the conservative treatment of lumbar spinal stenosis. A retrospective chart review was conducted in a subset of patients with chronic low back pain and lumbar spinal stenosis managed with low dose tricyclic antidepressants. Of 26 patients, 20 reported improvement in back pain. The majority of patients reported improvement with an initial dose of 10 mg of either amitriptyline or nortriptyline and remained on this dose. Patients with both leg and back pain reported improvement in greater proportion than patients with back pain alone. According to this study tricyclic antidepressants appear to be effective in controlling lumbar spinal stenosis symptoms in this patient population. Tricyclic antidepressants need to be further analyzed in randomized controlled studies as a means to conservatively manage lumbar spinal stenosis with stratification based on location of pain.