Effect of low-dose amitriptyline on low back pain with a neuropathic component: a post hoc analysis

Abstract

Low back pain (LBP) is a major, global health problem, with limited effective treatments [ [1] Global Burden of Disease 2019 Diseases and Injuries CollaboratorsGlobal burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1204-1222 Abstract Full Text Full Text PDF PubMed Scopus (492) Google Scholar , [2] Maher C Underwood M Buchbinder R Non-specific low back pain. Lancet. 2017; 389: 736-747 Abstract Full Text Full Text PDF PubMed Scopus (595) Google Scholar ]. We recently conducted a clinical trial to examine the efficacy of a low-dose tricyclic antidepressant (TCA; amitriptyline) in those with chronic, nonspecific LBP [ [3] Urquhart D Wluka A van Tulder M Heritier S Forbes A Fong C et al. Efficacy of low-dose amitriptyline for chronic low back pain: a randomized clinical trial. JAMA Intern Med. 2018; 178: 1474-1481 Crossref PubMed Scopus (21) Google Scholar ]. Although we found no statistically superior effect favoring low-dose amitriptyline for our primary outcome, there was a significant improvement in disability and consistent evidence across multiple outcomes to suggest a beneficial effect. Given LBP is a complex, heterogeneous condition [ [2] Maher C Underwood M Buchbinder R Non-specific low back pain. Lancet. 2017; 389: 736-747 Abstract Full Text Full Text PDF PubMed Scopus (595) Google Scholar ], we hypothesized that a specific patient subgroup may benefit from treatment with a low-dose TCA.