Antidepressant Amitriptyline Might Help Ease Low Back Pain

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Low doses of the tricyclic antidepressant amitriptyline may provide some relief for chronic low back pain, a JAMA Internal Medicine study suggests.

Nearly 150 adults with chronic, nonspecific low back pain were randomized to receive either low-dose (25 mg) amitriptyline or 1-mg benztropine (an active control with similar adverse events as amitriptyline) every day for 6 months.

The primary outcome — pain intensity at 3 and 6 months — was lower with amitriptyline, but the difference between the treatments was not statistically significant. However, the amitriptyline group did have significantly lower disability scores at 3 months. Few adverse events were reported at 6 months.

The authors conclude: "Although large-scale clinical trials that include dose escalation are needed, it may be worth considering low-dose amitriptyline if the only alternative is an opioid."