Advancing chronic low back pain management: Insights from amitriptyline and duloxetine comparison

Chronic low back pain (CLBP) is a leading cause of disability worldwide, yet optimal pharmacological management remains debated. This letter to the editor appraises the observational study by Sardar et al, which compared amitriptyline and duloxetine in a tertiary rehabilitation setting. The study, involving 254 patients, demonstrated that amitriptyline provided rapid early pain relief, while duloxetine offered more sustained pain reduction at 12 weeks with fewer anticholinergic and sedative side effects. These findings are consistent with existing evidence supporting duloxetine's efficacy and tolerability in chronic pain management. Although the absence of a placebo group limits causal inference, the study underscores the importance of individualized treatment strategies. We recommend further randomized controlled trials to validate these findings and strengthen evidence-based guidelines for CLBP management.