Using Elavil (Amitriptyline) for Back Pain

Benefits and Side Effects

Elavil (amitryptyline) is an antidepressant medication that can be effective as an adjuvant treatment for chronic back pain—that is, a medication given along with pain medication. It can be very helpful for back pain, but it does come with some side effects and drug interactions.

The brand name Elavil was discontinued in 2006, but the generic version of this medication is still available in the United States.

Type of Drug and What Amitriptyline Does

Diagram of an amitriptyline molecule.
Laguna Design/Science Photo Library/Getty Images.

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.

Elavil is not a narcotic (opioid) drug, and there is not usually an addiction risk with the medication.

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.

Your healthcare provider will likely start you at a very low dose and then increase upwards a little each week until your pain is relieved and/or the side effects become too much for you.

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.

If you are pregnant or breastfeeding, it's best to stay away from Elavil (amitriptyline) because the drug could possibly be passed on to your child.

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.

It is important to tell your healthcare provider everything you are taking, whether recreational, over-the-counter or prescribed. For example, the herbal preparation St. John's Wort should not be used with amitryptyline.

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.


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.


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)

A Word From Verywell

The antidepressant medication amitryptyline may be effective as an adjuvant treatment for the relief of chronic back pain. It appears to work particularly well for neuropathic pain, pain that may radiate down your leg and cause numbness, tingling, or pin-prick sensations. This type of pain tends to be one of the more difficult types of pain to treat.

It's not certain exactly how Elavil works, but the mechanism appears to be different than how it works for depression. A smaller dose is usually used.

There are both mild and serious side effects with amitryptyline and it's important to talk to your healthcare provider about these. In addition, there are several drugs which can interact with amitryptyline. Your healthcare provider should have a comprehensive list of your prescription, over-the-counter, and herbal medications before prescribing this drug.

Frequently Asked Questions

  • Why did they discontinue Elavil?

    Drug manufacturer AstraZeneca discontinued Elavil in 2003 after reports of potential cardiovascular side effects. However, in 2017, the Food and Drug Administration determined that amitriptyline was "not withdrawn from sale for reasons of safety or effectiveness." The generic version—amitriptyline—is still available in the United States.

  • Is amitriptyline a narcotic?

    No, amitriptyline is not a narcotic. It is a tricyclic antidepressant.

  • Is amitriptyline a sleeping pill?

    Not typically. However, amitriptyline is sometimes prescribed off-label as a sleeping pill. Taking amitriptyline can make you sleepy.

  • Is amitriptyline the same drug as gabapentin?

    No, but both are used for treating nerve pain. While amitriptyline is a tricyclic antidepressant, gabapentin is an anticonvulsant (anti-epileptic) drug.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Determination that ELAVIL (Amitriptyline Hydrochloride) Oral Tablets, 10, 25, 50, 75, 100, and 150 Milligrams, were not withdrawn from sale for reasons of safety or effectiveness.

  2. Thour A, Marwaha R. Amitriptyline. In: StatPearls. Treasure Island (FL): StatPearls Publishing.

  3. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;2015(7):CD008242. doi:10.1002/14651858.CD008242.pub3

  4. Kalita J, Kohat AK, Misra UK, Bhoi SK. An open labeled randomized controlled trial of pregabalin versus amitriptyline in chronic low backache. J Neurol Sci. 2014 Jul 15;342(1-2):127-32. doi: 10.1016/j.jns.2014.05.002

  5. Urquhart DM, Wluka AE, Sim MR, et al. Is low-dose amitriptyline effective in the management of chronic low back pain? Study protocol for a randomised controlled trialTrials. 2016;17(1):514. doi:10.1186/s13063-016-1637-1

  6. Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J. Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care databaseBMJ. 2015;350:h517. doi:10.1136/bmj.h517

  7. U.S. National Library of Medicine MedlinePlus. Amitriptyline.

Additional Reading
  • Fink K. Telephone Interview. National Rehabilitation Hospital.

  • Kasper DL, Fauci AS, Hauser SL. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education. Print.

  • van den Driest J, Bierma-Zeinstra S, Bindels P, Schiphof D. Amitriptyline for musculoskeletal complaints: a systematic review. Family Practice. 34(2):138-146.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.