Low-Dose Amitriptyline for Chronic Low Back Pain

To the Editor We read the article “Efficacy of Low-Dose Amitriptyline for Chronic Low Back Pain: A Randomized Clinical Trial” by Urquhart and colleagues, in which the authors found a significant reduction in disability at 3 months following treatment with amitriptyline but not at 6 months. The other outcome parameters, such as p ain intensity and work absence and hindrance, were not significantly different between the amitriptyline and the control groups. Adverse effects of a drug are an important outcome measure. A drug may be effective but may not be used because of its severe adverse effects, such as reserpine for hypert ension. In the study by Urquhart et al, use of benztropine mesylate as a comparator in the control arm has neutralized the difference in the adverse effects of amitriptyline. Amitriptyline is usually avoided in elderly individuals because of its adverse effects such as urinary retention, glaucoma, c ardiac arrhythmia, confusion, etc. Was there any difference in adverse effects between patients older vs younger than 65 years? Chronic backache below the costal margin and above the gluteal fold may be owing to vitamin D deficiency or hypothyroidism, which responds to specific treatment and not to amitriptyline. Were vitamin D levels and thyroid function tests obtained? This would be more appropriate for those patients who did not respond to treatment. Figure 2B in the article needs clarification. The Ronald Morris Disability Questionnaire score ranges bet...
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research