Amitriptyline for musculoskeletal complaints: a systematic review

Area of Science:

• Pharmacology
• Pain Management
• Rheumatology

Background:

• The efficacy of amitriptyline for musculoskeletal pain is less established than for neuropathic pain.
• Musculoskeletal conditions encompass a wide range of pain disorders affecting muscles, bones, and joints.

Purpose of the Study:

• To evaluate the efficacy and effectiveness of amitriptyline in managing pain associated with musculoskeletal complaints.
• To synthesize evidence from randomized controlled trials on amitriptyline's use in musculoskeletal pain.

Main Methods:

• A comprehensive literature search was conducted across major databases (Medline, Embase, Web of Science) up to April 2016.
• Included studies were randomized controlled trials comparing amitriptyline to placebo, usual care, or other analgesics.
• Risk of bias assessment and analysis of pain reduction and functional improvement were performed.

Main Results:

• Seven trials were included, focusing on low back pain, rheumatoid arthritis, and repetitive arm pain.
• Two low-risk-of-bias studies reported positive outcomes for amitriptyline.
• One study showed amitriptyline (50 mg/day) superior to pregabalin (600 mg/day) in reducing pain and improving function; another demonstrated functional improvement in arm pain versus placebo.

Conclusions:

• Limited studies exist on amitriptyline for musculoskeletal complaints.
• Amitriptyline may be effective, but more research is needed to identify patient subgroups who benefit most compared to other analgesics.