Abstract
Chronic neck pain (CNP) is a major concern for pain therapists. Many drugs including antidepressants such as amitriptyline have been used in the management of CNP. This study compared the efficacy and safety of 2 different doses of amitriptyline (5 mg and 10 mg at bedtime) in patients with CNP. A total of 80 patients of both sexes with idiopathic CNP, ranging in age from 18 to 75 years, were divided into 2 groups that received 5 or 10 mg oral amitriptyline at bedtime for 120 days. The primary outcome measure was neck pain disability index (NPDI). Neck pain intensity, Athens Insomnia Scale score, Hospital Anxiety and Depression Scale (HADS), side effects of the drug, and patient satisfaction were secondary outcome measures. NPDI decreased by 71.9% ± 13.4% in the 10 mg group compared to 47.3% ± 17.3% in the 5 mg group, representing a statistically significant difference (95% confidence interval: 27.3–12.6). Additionally, the 10 mg group showed greater mean reductions in pain score and HADS scores (both the anxiety and depression subscales), as well as improvement in sleep disturbance compared to the 5 mg group. A higher dose (10 mg) of amitriptyline at bedtime significantly reduced neck pain intensity, sleep disturbance, and anxiety and depression compared to a lower dose (5 mg) in patients with idiopathic and nontraumatic CNP after 120 days of treatment, with no significant difference between groups in the rate of side effects.
Highlights
Idiopathic chronic neck pain (CNP) is a common and debilitating condition, its management is not always optimal
CNP has been shown to be associated with increased sympathetic activity [4]; abnormal changes in heart rate during sleep reflecting autonomic dysregulation were observed among workers with chronic neck and shoulder pain [5], with similar findings reported in individuals with CNP [6, 7]
There were no differences in age, body mass index, neck pain disability index (NPDI), pain score, Athens Insomnia Scale (AIS), and Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales (HAD-A and -D, resp.) between the 2 groups (Table 2)
Summary
Idiopathic chronic neck pain (CNP) is a common and debilitating condition, its management is not always optimal. CNP is a musculoskeletal disorder characterized by continuous or recurrent pain lasting at least 3 months [1] that affects 10%–20% of the general population and is more common in women and people affected by psychosocial stress, specific neck and shoulder injuries, and repetitive physical strain, with a peak prevalence between the ages of 55 and 64 years [1]. CNP has been shown to be associated with increased sympathetic activity [4]; abnormal changes in heart rate during sleep reflecting autonomic dysregulation were observed among workers with chronic neck and shoulder pain [5], with similar findings reported in individuals with CNP [6, 7]. Chronic musculoskeletal pain has different underlying mechanisms including amplification of nociceptive input from myofascial A-delta and C fibers, second-order spinal neuron sensitization, stimulation of supraspinal neurons that facilitates pain conduction, and decreased activation of descending antinociceptive pathways [9]. Chronic musculoskeletal pain has different underlying mechanisms including amplification of nociceptive input from myofascial A-delta and C fibers, second-order spinal neuron sensitization, stimulation of supraspinal neurons that facilitates pain conduction, and decreased activation of descending antinociceptive pathways [9]. ese mechanisms are likely interrelated, as central sensitization can be achieved by sustained nociceptive inputs from peripheral myofascial tissues [10]
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