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Amitriptyline for fibromyalgia in adults.

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Area of Science:

  • Pharmacology
  • Rheumatology
  • Clinical Trials

Background:

  • Amitriptyline, a tricyclic antidepressant, is commonly used for fibromyalgia pain management, often at sub-antidepressant doses.
  • This review is an update focusing solely on fibromyalgia, separating it from neuropathic pain efficacy.

Purpose of the Study:

  • To evaluate the pain-relieving effectiveness of amitriptyline in fibromyalgia patients.
  • To assess the incidence of adverse events associated with amitriptyline use in clinical trials.

Main Methods:

  • Systematic review and meta-analysis of randomized, double-blind studies of at least four weeks' duration.
  • Searched multiple databases (CENTRAL, MEDLINE, EMBASE) up to March 2015.
  • Analyzed evidence in three tiers based on risk of bias and study quality.

Main Results:

  • Nine studies (649 participants) were included; no high or medium-tier evidence found.
  • Third-tier evidence suggested amitriptyline may provide pain relief (NNT 4.1), but this evidence was of very low quality.
  • Adverse events were more frequent with amitriptyline (78%) versus placebo (47%), with a Number Needed to Harm (NNH) of 3.3.

Conclusions:

  • Despite widespread use, high-quality evidence supporting amitriptyline's efficacy for fibromyalgia is lacking.
  • The observed benefits may be overestimated; only a minority of patients achieve satisfactory pain relief.
  • Amitriptyline remains an option, but its use should consider potential adverse events and limited evidence of significant benefit.