Low-dose antidepressants ease back pain

A low dose of the antidepressant amitriptyline is an effective alternative to narcotics for treating back pain, according to new research.

A Monash University study, published in JAMA Internal Medicine, is the first to investigate the use of low-dose antidepressants to treat back pain. It examined whether a daily low dose of the tricyclic antidepressant amitriptyline (25 mg) could reduce pain, disability and time off work over 3 and 6 months in 146 people with chronic back pain.

Back pain is the world’s leading cause of disability, affecting half a billion people worldwide. While there are a variety of treatments available, effective therapies are limited.

The use of antidepressants to treat back pain is rapidly increasing, with high doses prescribed for depression and lower doses for chronic pain. However, there is currently a lack of evidence for their effectiveness, particularly for the use of low doses.

The trial found that those on low-dose antidepressants had less back-related disability at 3 months and tended to have less pain at 6 months compared to those on placebo. The antidepressant was also well tolerated with minimal side effects reported.

The investigators concluded that the low-dose antidepressant amitriptyline may be an effective treatment for back pain, although large-scale clinical trials are still needed to clarify its efficacy.

The study also suggested that until further evidence is available it may be worth considering low-dose amitriptyline for the treatment of back pain, if narcotics are the only alternative.

Lead author Dr Donna Urquhart, of the Monash Department of Epidemiology and Preventive Medicine, said, “The key to managing chronic back pain is to stay active. However, some patients and their doctors may decide they need some extra help in the form of medications to manage their back pain.

“We found that low-dose amitriptyline improved back pain and disability, which are factors that can stop someone being active, and thus may serve as a valuable treatment option.”

Recent studies have shown that medications such as paracetamol, anti-inflammatories and narcotics don’t work for chronic low back pain, leaving physicians looking for alternatives,” Dr Urquhart said.

Despite this, narcotics are still commonly prescribed and are contributing to an epidemic of use, with 50% of increased use attributed to back pain treatment. This has also resulted in a rapid increase in the serious harms associated with narcotic use, such as addiction and depression.

“The key message for people with chronic back pain is to stay active,” Dr Urquhart said. “However, if they need additional support in the short to medium term, low-dose amitriptyline may be worth considering.”

For further information on back pain and musculoskeletal studies conducted by the Monash University Musculoskeletal Unit, visit its website, call (03) 9903 0553 or email: jointstudy@monash.edu.

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