For years doctors have prescribed the antidepressant amitriptyline (Endep, Entrip) in low doses for chronic non-specific low back pain together with painkillers. But is it effective?
This is very relevant given that according to Reuters Health seven out of the fourteen national and international guidelines recommend their use for this problem.
A group of researchers at Monash University set to find out with a randomised control trial. Their report has been published in the Journal of the American Medical Association (JAMA Internal Medicine) this month.
They followed two groups with chronic non-specific low back pain over a six-month period and found that there was no statistical difference in the level of pain at three months or six months between those on amitriptyline and those not.
Similarly, they found no difference in work-related outcomes, absenteeism and hindrance. However, there was a statistically significance in reduction in disability at three months, but not six. Though statistically significant, the amount of reduction was clinically not significant. I.e. most patients and their doctors would not be able to notice the small improvement.
Yet their conclusion is: “This trial suggests amitriptyline may be an effective treatment for chronic low back pain”. Go figure. They said, “it may be worth considering if the only alternative is an opioid”.
What they and most doctors don’t consider is that there is another alternative: acupuncture.
The Acupuncture Evidence Project reports: “Acupuncture may be effective for pain and functional limitation in chronic non-specific low back pain: Evidence Level 1”
Level 1 evidence is the highest ranked evidence. I know which I would prefer if I had this problem.
Follow Dr Alex Joannou on LinkedIn.