So I just read a recent study that I found mildly disturbing. In my opinion it’s a case of we have this drug we need to find a disease for. This study was on low-dose amitriptyline and it’s use for treating chronic low back pain. So the question is should I take an antidepressant for back pain?
Amitriptyline is an antidepressant but it is not used as the first drug of choice because of it’s side effects and that people tend to not be able to tolerate it well. Instead doctors typically prescribe SSRI’s such as Prozac, Paxil, Zoloft more often. But amitiptyline is cleared to treat migraine headache, fibromyalgia, and neuropathic pain as well. The antidepressant class of drugs have been used to treat chronic back pain but no studies have shown that this is effective. This study was performed to examine if amitriptyline could impact pain, disability, and work absence in patients with chronic low back pain. The authors measured outcomes at both 3 months of use and 6 months of use of the drug and compared to the use of an anti-psychotic drug which is known to not have any affect on pain. Interestingly enough they did not test against a placebo.
In their conclusion the authors say that low dose amitriptyline is effective option to treat chronic low back pain if the only alternative is an opioid. The results are not nearly as optimistic. In their results the study shows that amitiptyline has no analgesic effect, no pain relieving effect. That disability was decreased at 3 months but not after 6 months of use. That there was no increase in days worked at 3 or 6 months of use. That there was no difference in pain scores compared to the group that took the other drug, that has no pain relieving effect. So the authors conclusion that amitriptyline is effective is based only on an improvement in disability scores seen after 3 months of use but not after 6.
Basically if you take this drug to treat chronic low back pain expect an improvement in disability score after 3 months which doesn’t last after 6 months of use. Disability scores are a measurement of how well you walk, sit, stand, drive your car, sleep, and are able to tolerate your social life with pain. You cannot expect any relief of pain or fewer missed days of work whether you take it for 3 months or 6 months. Really, does the authors conclusion really match the results? I guess that is why they throw in the last sentence that if the only other option is an opioid this might be better. In reality it does not look like taking this antidepressant is at all a viable option to treat chronic back pain.
Common side effects include dizziness, headache, weight gain, cognitive effects such as delirium and confusion, mood disturbances such as anxiety and agitation, cardiovascular side effects such as orthostatic hypotension, sinus tachycardia, and QT-interval prolongation, loss of libido and impotence, and sleep disturbances such as drowsiness, insomnia and nightmares. I don’t know about you but for the improvement of my quality of life after 3 months use but not after 6, these side effects wouldn’t be worth it.
Should I take an antidepressant for back pain? I would think that despite the conclusion of this study, the results of this study would lean to a hard NO! Instead there are better options out there than just masking the pain or dulling your senses with drugs. We are chiropractors so of course we are going to say “try chiropractic care” but not just any chiropractic care. The type of chiropractic care we promote which is to restore the spine and posture to the normal upright position. This type of care has been actually proven in multiple studies to be effective in both the short term and long term in relieving pain and improving quality of life. Read though this blog for links to those studies. In extreme cases surgery is an option and we routinely work with pain management doctors because in tough cases steroid injections can help us, help you, better.
If you are curious about what we do, read through this blog. Or better yet give us a call we would be happy to discuss with you, your specific circumstance and how we might be able to help. 630-232-6616.