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

Area of Science:

• Neurology
• Pain Management
• Pharmacology

Background:

• Chronic neck pain (CNP) treatment remains controversial.
• Amitriptyline's efficacy is established for other chronic pain conditions but not specifically tested for CNP.
• Idiopathic CNP affects a significant patient population with unmet treatment needs.

Purpose of the Study:

• To evaluate the effectiveness and safety of low-dose amitriptyline for managing idiopathic chronic neck pain.
• To assess amitriptyline's impact on pain intensity, disability, insomnia, anxiety, and depression in CNP patients.
• To determine patient satisfaction with amitriptyline treatment for CNP.

Main Methods:

• A randomized controlled trial involving 220 patients with idiopathic CNP.
• Participants received either 5 mg of amitriptyline at bedtime or a placebo for two months.
• Outcomes measured included visual analog scale (VAS) for pain, neck pain disability index (NPDI), Bergen Insomnia Score (BIS), and Hospital Anxiety and Depression Scale (HAD).

Main Results:

• The amitriptyline group showed significantly lower VAS pain scores compared to placebo (p < 0.0001).
• Patients on amitriptyline experienced a 53% improvement in pain from baseline versus 14% in the placebo group (p < 0.0001).
• Significant improvements were also noted in NPDI, BIS, HAD-A, HAD-D, and patient satisfaction in the amitriptyline group.

Conclusions:

• Low-dose amitriptyline is an effective treatment for idiopathic chronic neck pain.
• The medication demonstrates a favorable side effect profile and high patient satisfaction.
• This study extends the therapeutic indications of low-dose amitriptyline to chronic neck pain management.