Is Amitriptyline Of Benefit To Neuropathy Patients?

Today's post from nzdoctor.co.nz (see link below) talks about the effectiveness of Amitriptyline for the relief of neuropathic symptoms. Amitriptyline is one of the first line of drugs generally prescribed for neuropathy problems, after the over the counter analgesics. It's an anti-depressant and seems to work for some patients and not others. The article here suggests that it is probably ineffective for chemotherapy or HIV-related forms of neuropathy but possibly works for diabetes-related nerve problems and neuropathy stemming from other conditions. Unfortunately, it doesn't explain why or how these conclusions have been reached and that is what we really need to know. Doing further research on the internet yourself will undoubtedly give you more information, or failing that, doing a search here on this blog (on the right of the page) for amitriptyline will bring up more articles about its use in treating neuropathy. You could also ask your doctor, or specialist to explain the differences in effectiveness. Many patients will be confused that a medication is thought to work for neuropathy caused by one disease but not another, especially when the symptoms are very much the same, irrespective of the cause - further information is therefore necessary. The article also fails to mention the possible side effects of taking amitriptyline, which once again, can be a problem for some but not for others.

Limited evidence for benefit of amitriptyline for neuropathic pain and fibromyalgia in adults

Wednesday 13 March 2013, 11:23AM

PEARLS 382, February 2013, written by Brian R McAvoy.

(DownloadsPEARLS 383 PDF)

Clinical question
How effective is amitriptyline for neuropathic pain and fibromyalgia in adults?

Bottom line
Amitriptyline probably does not work in neuropathic pain associated with HIV or treatments for cancer. Amitriptyline probably does work in other types of neuropathic pain (painful diabetic neuropathy, post-herpetic neuralgia, and post-stroke pain, and in fibromyalgia), though we cannot be certain of this. A best estimate is that amitriptyline provides pain relief in about 1 in 4 (25%) more people than does placebo (NNT* = 4.6 [95% confidence interval 3.6Ð6.6]), and about 1 in 4 (25%) more people than placebo report having at least 1 adverse event, probably not serious but disconcerting.*NNT = number needed to treat to benefit 1 individual.

Caveat
There were no studies that could provide an answer that was trustworthy or reliable because most studies were relatively old, and used methods or reported results that we now recognise can make benefits seem better than they are.

Context
Amitriptyline is a tricyclic antidepressant that is widely used to treat chronic neuropathic pain and fibromyalgia, and is recommended in many guidelines. These types of pain can be treated with antidepressant drugs in doses below those at which the drugs act as antidepressants.

Cochrane Systematic Review
Moore RA et al. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Reviews, 2012, Issue 12. Art. No.: CD008242.DOI: 10.1002/14651858. CD008242.pub2.

This review contains 21 studies involving 1437 participants.

http://www.nzdoctor.co.nz/gp-resources/pearls/2013/march-2013/13/limited-evidence-for-benefit-of-amitriptyline-for-neuropathic-pain-and-fibromyalgia-in-adults.aspx