The analgesic effect of amitriptyline on chronic facial pain.
The efficacy of amitriptyline was evaluated in 28 patients with chronic oral-facial pain. Most of the patients had evidence of musculoskeletal pain while some had a history suggesting pain of neurogenic origin. Two patients had mixed elements of neurogenic and musculoskeletal pain. Amitriptyline was more effective than placebo in reducing pain after 4 weeks of treatment. No effect was found after only 1 week of drug administration in either dose range. When the patients were divided into depressed and non-depressed groups based on their Hamilton depression scores, amitriptyline reduced pain in the depressed and in the non-depressed groups as compared to placebo. Amitriptyline reduced the depression scores in the depressed group but had no effect on the depression scores in the non-depressed group. Thus, pain reduction was not associated with a change in mood in the non-depressed group. Amitriptyline had no effect on patients' ratings of the intensity of experimental heat stimuli. We conclude that amitriptyline is effective in the treatment of chronic oral-facial pain and that its efficacy is independent of its effects on depression. It appears that tricyclic antidepressants act in a fashion different from opiate drugs that alter the sensory discriminative component of pain.
Pain Research Clinic, Neurobiology and Anesthesiology Branch, National Institute of Dental Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892 U.S.A. Department of Oral Diagnosis, Oral Medicine and Oral Radiology, Hebrew University - Hadassah School of Dental Medicine, JerusalemIsrael.
Yair
Y
Sharav
Elyse
E
Singer
Elizabeth
E
Schmidt
Raymond A
RA
Dionne
Ronald
R
Dubner
D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage / Q000627:therapeutic use*; D000704:Analysis of Variance; D002908:Chronic Disease; D003863:Depression / Q000150:complications; D004305:Dose-Response Relationship, Drug; D005157:Facial Pain / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged
D000639:Amitriptyline