Doctor, I have fibromyalgia. Is amitriptyline a good option for treating my symptoms?

Amitriptyline is effective at treating fibromyalgia compared to placebo with benefits that range from small to large depending on the symptom.

What is the evidence?

SUMMARY OF FINDINGS

Amitriptyline, Duloxetine, Milnacipran, and Pregabalin vs placebo at 12 weeks (range of 4 to 52 weeks)

Outcomes	Amitriptyline vs placebo (10 studies: all low risk of bias*)	Duloxetine vs placebo (8 studies: all low risk of bias)	Milnacipran vs placebo (11 studies: all low risk of bias)	Pregabalin vs placebo (7 studies: all low risk of bias)
Pain (35 studies; 11,423 pts)	small reduction in pain	small reduction in pain	small reduction in pain	small reduction in pain
Sleep (16 studies; 4,452 pts)	large improvement in sleep	small improvement in sleep	no effect on sleep	moderate improvement in sleep
Depression (19 studies; 8,138 pts)	no effect on depression	small reduction in depression	small reduction in depression	small reduction in depression
Fatigue (21 studies; 8,172 pts)	moderate reduction in fatigue	small reduction in fatigue	small reduction in fatigue	small reduction in fatigue
Quality of Life (25 studies; 10,219 pts)	large improvement in quality of life	small improvement in quality of life	no effect on quality of life	small improvement in quality of life
Acceptability (stopping drug due to adverse effects) (26 studies; 9,833 pts)	not more likely than placebo to be stopped due to adverse effects	more likely than placebo to be stopped due to adverse effects	more likely than placebo to be stopped due to adverse effects	more likely than placebo to be stopped due to adverse effects

*low risk of bias = low risk that the study has method or design errors that would affect the accuracy of the results

What kind of study was this?

This was a systematic review of 36 randomized controlled studies published up to July 2020.

Who? This review included 11,930 adults (average age 48 years; 94% women) with fibromyalgia.

What? The reviewers included studies that compared amitriptyline with placebo or other drugs (duloxetine, milnacipran or pregabalin) for treatment of fibromyalgia.

Amitriptyline	vs	Placebo/Another treatment
Amitriptyline, 10 to 50 mg per day for 6 to 24 weeks		Placebo: A pill/needle/lotion containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill." Another treatment: Duloxetine, 60 to 120 mg per day for 12 to 52 weeks; Milnacipran, 25 to 200 mg per day for 12 to 52 weeks; Pregabalin, 150 to 600 mg per day for 8 to 17 weeks

Amitriptyline

Placebo/Another treatment

Amitriptyline, 10 to 50 mg per day for 6 to 24 weeks

Placebo: A pill/needle/lotion containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill."

Another treatment: Duloxetine, 60 to 120 mg per day for 12 to 52 weeks; Milnacipran, 25 to 200 mg per day for 12 to 52 weeks; Pregabalin, 150 to 600 mg per day for 8 to 17 weeks

Why was this research done?

Fibromyalgia is a condition that causes widespread pain lasting for at least 3 months without any apparent inflammation or damage to tissues. People with fibromyalgia often also experience fatigue, depression, anxiety, and sleep problems. Researchers wanted to know if amitriptyline, an older drug, is as good as three newer drugs for treatment of fibromyalgia. None of the studies directly compared amitriptyline with the newer drugs so researchers looked at the results for studies comparing each drug with placebo. The results showed amitriptyline improved most symptoms due to fibromyalgia except depression. Concerns about this review include lack of direct comparisons between amitriptyline and the other drugs.

This Evidence Summary is based on the following article:

Farag HM, Yunusa I, Goswami H, et al. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2022 May 2;5(5):e2212939. doi: 10.1001/jamanetworkopen.2022.12939. PubMed

Published: Monday, October 31, 2022

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the PAIN+ CPN website on 2024/12/21.

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