The tricyclic antidepressants have largely been overtaken by the selective serotonin reuptake inhibitors and other, newer varieties of antidepressants. These new medications typically have fewer side effects while being just as effective, if not more so, than their predecessors at reducing the symptoms of depression. However, many of the tricyclic drugs have effects that go beyond mood stabilization. Recently, research on Elavil (amitriptyline) has focused on whether this medication might be useful in the treatment of various forms of pain. Chronic pain is a frequent cause of disability and reduced quality of life. Acute pain, such as that experienced after surgery, often requires powerful, opioid pain medications. In both of these scenarios, Elavil has potential as a safe and effective treatment option.
One such study in Boston involved using low doses of Elavil as a treatment for repetitive motion injuries to the arm, such as carpal tunnel. The 6-week trial included a placebo group for the purpose of comparison. Subjects were volunteers with a diagnosis of repetitive use injury and an average pain level of 3 on a scale of 1 to 10. At the end of the trial, Elavil performed no better than placebo in terms of pain reduction. However, subjects given Elavil reported significant improvement to both arm function and sense of well-being. The most commonly reported side effect was drowsiness, but this tended to diminish toward the end of the study. When the study concluded, subjects in the Elavil group reported a reduction in well-being and arm function, a confirmation that the positive effects of the drug were not illusory.
Another recent study attempted to gauge the safety of administering Elavil before surgery, with the aim of reducing postoperative pain. One subject experienced a dangerous adverse effect at a dosage of 100 mg, and the trial was stopped. Researchers concluded that further testing should be done at the 25- to 50-mg level but no higher. There is some evidence that Elavil may successfully reduce the lingering pain of major surgery; however, more data are needed before conclusions may be drawn.
Researchers don’t completely understand the chemistry behind the pain-reducing properties of Elavil. The current theory is that the medication blocks communication between certain neurons that are associated with pain. Because of its possible effectiveness at low doses and relative safety compared to stronger painkilling medications, further study is certainly called for. Less disruptive forms of pain management will undoubtedly lead to a better quality of life for those who deal with pain every day.
References
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Amitriptyline. Retrieved March 19, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000666/
- Fridrich, P., Colvin, H. P., Zizza, A., Wasan, A. D., Lukanich, J., Lirk, P., et al. (2007). Phase 1A safety assessment of intravenous amitriptyline. Journal of Pain, 8(7), 549-555.
- Goldman, R.H., Stason, W.B., Park, S.K., Kim, R., Mudgal, S., Davis, R.B., et al. (2010). Low dose amitriptyline for treatment of persistent arm pain due to repetitive use. Pain, 149(1), 117-123.
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