title: Low-dose amitriptyline for treatment of persistent arm pain due to repetitive use.
abstract: Amitriptyline is sometimes used to treat arm pain related to repetitive use, but rigorous evidence of its benefit is lacking. This randomized controlled trial investigated whether amitriptyline provided greater pain relief or improved arm function than a placebo pill in adults with arm pain associated with repetitive use that had persisted for at least 3 months. Participants (N=118) were randomly assigned to receive 25mg of amitriptyline or a placebo pill for 6 weeks. The primary outcome was intensity of pain (10-point numerical rating scale) and secondary outcomes were arm symptoms, arm function, grip strength, mood, and sleep. Assessments were done at baseline, 3 and 6 weeks of treatment, and 1 month after the treatment ended. Changes in arm pain were not statistically significant. However, the amitriptyline group improved more than the placebo group in arm function (p=0.023) and sense of well being (p=0.034). In a longitudinal analysis, the amitriptyline group's arm function score improved 0.45 points per week faster than placebo after adjusting for subject characteristics (p=0.015). At the treatment's midpoint, the amitriptyline group reported more "troublesome side-effects" than the placebo group (52.5% vs. 27.1%, p=0.005), but this difference decreased by the end of the treatment (30.5% vs. 22.0%, p=0.30). The most frequent side effect was drowsiness. In conclusion, this study found that low-dose amitriptyline did not significantly decrease arm pain among these participants but did significantly improve arm function and well being. Future research is needed to explore the effects of higher doses and longer duration of treatment.
authors.affiliation: Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA University of Michigan School of Public Health, 109 S. Observatory Street, Building 1-6667, Ann Arbor, MI 48109, USA WHO European Centre for Environment and Health, Hermann-Ehlers-Str.1053113 Bonn, Germany Osher Research Center of Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA.
authors.forename: Rose H
authors.initials: RH
authors.lastname: Goldman
authors.forename: William B
authors.initials: WB
authors.lastname: Stason
authors.forename: Sung Kyun
authors.initials: SK
authors.lastname: Park
authors.forename: Rokho
authors.initials: R
authors.lastname: Kim
authors.forename: Sharmila
authors.initials: S
authors.lastname: Mudgal
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Ted J
authors.initials: TJ
authors.lastname: Kaptchuk
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D001132:Arm; D018771:Arthralgia / Q000188:drug therapy*; D002908:Chronic Disease; D012090:Cumulative Trauma Disorders / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000639:Amitriptyline