Analgesic Efficacy and Tolerability of Amitriptyline versus Mianserin in Chronic Low Back Pain: A Randomised, Double-Blind, Controlled Pilot Trial
3
Issued Date
2025-01-01
Resource Type
eISSN
11787090
Scopus ID
2-s2.0-105026504654
Journal Title
Journal of Pain Research
Volume
18
Start Page
6829
End Page
6847
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Pain Research Vol.18 (2025) , 6829-6847
Suggested Citation
Wangnamthip S., Eiamtanasate S., Saisavoey N., Sathienluckana T., Suthisiltham L., Panchoowong S., Tipapakoon I., Euasobhon P., Jensen M.P., Srirojanakul W. Analgesic Efficacy and Tolerability of Amitriptyline versus Mianserin in Chronic Low Back Pain: A Randomised, Double-Blind, Controlled Pilot Trial. Journal of Pain Research Vol.18 (2025) , 6829-6847. 6847. doi:10.2147/JPR.S568131 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113991
Title
Analgesic Efficacy and Tolerability of Amitriptyline versus Mianserin in Chronic Low Back Pain: A Randomised, Double-Blind, Controlled Pilot Trial
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Abstract
Purpose: Chronic low back pain (CLBP) is a complex, disabling condition that often necessitates multimodal treatment. Although tricyclic and tetracyclic antidepressants are recommended as adjunctive therapy, comparative efficacy data remain extremely limited. Patients and Methods: We conducted a randomised, double-blind, controlled trial in 24 individuals with CLBP to compare the efficacy and safety of amitriptyline with mianserin. Participants received amitriptyline (n = 15) or mianserin (n = 9) for 12 weeks with titrated dosing. Pain intensity (primary outcome), adverse effects, disability, health utility, quality of life, and psychological function were recorded at baseline and at each follow-up visit. Results: Participants in both groups reported significant within-group reductions in pain intensity from baseline to week 12. Mianserin was associated with a large effect size improvement (Cohen’s d = −1.40; 95% CI −2.71 to –0.08), and amitriptyline was associated with a medium effect size improvement (d = −0.55; 95% CI −1.19 to 0.08). Amitriptyline significantly improved EQ-5D-5L utility scores (Δ=+0.116, p=0.008; d=0.61, 95% CI 0.14 to 1.09) but was associated with more anticholinergic effects than mianserin. Mianserin was better tolerated; only transient drowsiness was reported. Different benefits were noted in some outcome measures as a function of treatment condition: amitriptyline reduced stress by week 6, whereas mianserin lowered anxiety at weeks 6 and 12. Conclusion: Both amitriptyline and mianserin appear to provide comparable adjunctive efficacy for CLBP. Mianserin may be more tolerable and cost-effective in resource-limited settings, although it is not yet approved for pain indications.