Effective Therapy for Chronic Neck Pain
by David Borenstein, MD Executive Editor 10/2020
Chronic neck pain (CNP) is an increasingly important musculoskeletal disorder as more and more individuals sit in front of computers for work and recreation. Although not as common as low back pain, neck pain affects 10 to 15% of the United States population each year.
My most frequent advice for my chronic neck pain patients is neck stretches while being seated or with the hourly breaks while walking away from the computer. In addition to stretching exercises and physical therapy, physical therapy that concentrates on good ergonomics can be very helpful.
Pharmacologic therapy can also be helpful to minimize neck pain. The assumption is that newer medications would be the ones that offer the best pain relief. That assumption is not always correct as evidenced by the study reported by Maarrawi.1
Amitriptyline is an anti-depressant that has been used as a treatment for depression for decades. Amitriptyline is also a therapy used in the treatment of fibromyalgia and other painful conditions. In this study, 220 patients suffering from CNP were randomized to placebo or amitriptyline 5mg at bedtime for 2 months. Patients with depression receive between 100 to 300 mg daily. The primary outcome measure of the study was change in visual pain scores. At the end of the study, the amitriptyline group had a 53% decrease in pain compared to a 14% decrease in the placebo group. Side-effects were greater with amitriptyline with 7% of patients withdrawing from the study of intolerance.
This study reports that an old drug at a low dose is effective in decreasing CNP as long as it is tolerated.
- Maarrawi J, et al. Randomized double-blind controlled study of bedtime low dose amitriptyline in chronic neck pain. Eur J Pain 2018 Feb 13. Doi. 10.1002/ejp. 1206