Amitriptyline for neuropathic pain and fibromyalgia in adults

Fibromyalgia

“…28 For amitriptyline alone one meta-analysis found a 2.9 (95% confidence interval 1.7 to 4.9) relative risk for an unspecified pain reduction. 29 (table 3). 30 The same systematic review found that the SMD for milnacipran was 0.20 (0.13 to 0.26) for pain, 0.14 (0.08 to 0.21) for fatigue, −0.02 (−0.10 to 0.05) for sleep problems, and 0.11 (0.04 to 0.17) for depression (table 3).…”

Treatment of fibromyalgia

“…However, for every 3.3 patients treated, one will have an adverse event. 35 Tolerance development and weight gain limit the use of amitriptyline, but in a small subgroup it can be very useful in the long term.…”

Presentation and management of chronic pain

“…Low dose amitriptyline (5–10 mg daily) is also used in children with some types of neuropathic pain, where its sedative effect can also be helpful if there is accompanying disordered sleep 4 20. The use of amitriptyline for other pain conditions is controversial although it is used in adults with fibromyalgia, where it is thought to reduce pain due to effects on central sensitisation, although a recent Cochrane review concluded that a positive effect is likely only in a minority of patients 21. Studies have concluded that amitriptyline is either not effective or there is insufficient evidence to support its use in childhood migraine or functional abdominal pain 22 23…”