title: A Randomized Controlled Trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in the treatment of chronic tension-type facial pain.
abstract: BACKGROUND
  Patients often present to otolaryngologists with chronic facial pain, presumed to be of sinus origin despite normal nasal endoscopy and sinus CT. This pain has increasingly been recognized as being of neurological origin with one of the commonest underlying causes being mid-facial segmental tension-type pain (MFP) which is a version of tension-type headache affecting the midface.
  
  
  OBJECTIVE
  
  
  
  METHODS
  1. To determine whether low-dose amitriptyline reduces pain scores compared to surrogate placebo in patients with chronic MFP. 2. To determine whether the addition of pindolol, a beta blocker with serotonin receptor blocking properties hastens onset of action or improves efficacy of amitriptyline.
  
  
  METHODS
  to determine whether amitriptyline or amitriptyline with pindolol significantly reduces analgesic consumption.
  
  
  METHODS
  Sixty two patients were randomized to three treatment groups (a) amitriptyline 10mg daily (b) amitriptyline 10mg daily with pindolol 5mg twice daily and (c) loratadine 10mg daily. Daily pain scores using a facial pain diary were recorded over eight weeks.
  
  
  RESULTS
  At 8 weeks, pain frequency and intensity were significantly reduced in patients treated with amitriptyline and in those receiving amitriptyline with pindolol compared to surrogate placebo. Patients on the combination therapy showed significantly improved clinical outcome and significantly reduced analgesic intake compared to those on amitriptyline alone.
  
  
  CONCLUSIONS
  Low dose amitriptyline is effective in the management of MFP and is enhanced by the addition of pindolol.
authors.affiliation: The Medical School, University of Malta, Msida, Malta. aagius@stannesclinic.com
authors.forename: A M
authors.initials: AM
authors.lastname: Agius
authors.forename: N S
authors.initials: NS
authors.lastname: Jones
authors.forename: R
authors.initials: R
authors.lastname: Muscat
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000639:Amitriptyline / Q000008:administration & dosage / Q000627:therapeutic use*; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D059350:Chronic Pain; D005157:Facial Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010869:Pindolol / Q000008:administration & dosage / Q000627:therapeutic use*; D010919:Placebos; D011446:Prospective Studies; D018781:Tension-Type Headache / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000929:Antidepressive Agents, Tricyclic; D010919:Placebos; D000639:Amitriptyline; D010869:Pindolol