Using Elavil (Amitriptyline) for Back Pain

Type of Drug and What Amitriptyline Does

Elavil (amitriptyline) is a tricyclic antidepressant. This type of medication is usually used to treat anxiety and depression, but it can also help treat chronic pain.

Amitriptyline is the most studied of all the tricyclic antidepressants and has been in use since the 1960s.

Amitriptyline works by increasing serotonin levels in your brain. This neurotransmitter plays a role in how your body responds to pain.

According to Dr. Kathleen Fink, Director of Pain Services at the National Rehabilitation Hospital in Washington D.C., this medication is underutilized due to the development of newer tricyclic antidepressants.

Off-Label Use for Back Pain

Elavil is sometimes prescribed off-label to treat chronic back pain. This means healthcare providers believe it can help people with back pain even though it is not approved for that use.

For back pain, Elavil is most often used along with other medications. Medications that are used in this way are referred to as adjuvant pain medications.

Elavil is not usually used as a first-line treatment, but instead, after more conservative treatments for back pain, such as Advil (ibuprofen) and Tylenol (acetaminophen) have been found ineffective for relieving the pain.

Elavil appears to be most effective for neuropathic (relating to nerves) chronic back pain. For spine pain sufferers, this usually means your pain radiates down an arm or leg. You may also have tingling or a pinprick sensation in your arm or leg.

Fink says healthcare providers may not be comfortable prescribing amitriptyline for chronic spine pain because the side effects can make you feel hungover in the morning. "But in reality, amitriptyline is an effective and inexpensive medication for managing chronic back pain, especially if you are also having problems sleeping," she notes.

A 2014 study published in the Journal of Neurological Science compared amitriptyline with Lyrica or pregabalin (another drug given for neuropathic pain) for reducing pain, as well as physical disability. The researchers found that while both were effective pain relievers, only amitriptyline significantly reduced disability as well.

Other Uses

Elavil is typically used to treat depression, anxiety, and related conditions. In addition to treating back pain, it has a number of other off-label uses, including:

• Chronic fatigue syndrome
  
• Irritable bowel syndrome (IBS)
• Diabetic neuropathy
• Headaches, including migraine
• Insomnia
  
• Fibromyalgia
  

Amitriptyline Dosage

The way antidepressants relieve back pain is independent from the anti-depressant effect, so the dosing is different. When Elavil is used for managing back or neck pain, the dose is lower (approximately half, although this will vary) than when it is taken for depression.

Positive effects often occur more speedily when this drug is taken for chronic back pain as compared to when it is used for managing depression.

Side Effects

It's important to be aware of the possible side effects of amitryptyline before beginning this drug. Some of the most common side effects are sleepiness, headache, and tremors.

Because amitriptyline is approved by the Food and Drug Administration (FDA) to treat depression, it can affect mental status, including increasing the risk of suicide. Relatively speaking, however, amitriptyline likely has a low risk of suicide.

For example, a 2015 cohort study published in the British Medical Journal found that in people with depression, the absolute risk of suicide for amitriptyline over one year was 0.02%. Certainly, people living with depression have an elevated risk of suicide even without this medication. If anyone in your family has bipolar disorder or suicide, your healthcare provider may recommend not using this medication.

Elavil can cause problems for people who have arrhythmias (abnormal heart rhythms) and other forms of heart disease, and it is not generally given to people over the age of 60. (The newer antidepressants may be a better choice for this age group.)

A few less serious Elavil side effects include dry mouth and drowsiness.

Drug Interactions

There are a number of drugs that interact with amitryptyline.

Interactions between Elavil and some other drugs can increase the amount of amitriptyline in your blood. In turn, this may increase the side effects of the medication. Interactions may also increase the toxicity (or decrease the efficacy) of the drugs you are taking along with Elavil.

Important interactions may occur between Elavil and some muscle relaxants, antidepressants, drugs for abnormal heart rhythms, drugs for high blood pressure, thyroid medications, birth control pills, and more. It is a good idea to talk to your pharmacist as well if you are prescribed Elavil.

Contraindications

There are some instances in which it is best to avoid taking amitriptyline altogether. These instances are referred to as "contraindications."

For example, if you are taking a monoamine oxidase inhibitor (MAOI) for depression or the heartburn medication cisapride (no longer available in the United States) you should not take amitryptyline. Also, do not take Elavil within 14 days of using an MAOI.

You should not use Elavil if you have a history of QTc prolongation, arrhythmias, recent myocardial infarction, or heart failure. Since Elavil may increase or decrease the level of other drugs you take, always talk to your healthcare provider before discontinuing your medication.

Alternatives

Other tricyclic antidepressants can be used as adjuvants to treat back pain. These include:

• Anafranil (clomipramine)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Silenor (doxepin)
• Tofranil (imipramine)
• Vivactil (protriptyline)