Amitriptyline

Rintala et al. 2007;
USA
PEDro=10
RCT
N=22

Population: SCI: Mean age = 42.6 yrs; Gender: males = 20, females = 2; Level of injury: paraplegia = 7, tetraplegia = 12; Severity of injury: AIS A-C = 19, D = 3; Time since injury = 12.6 yrs; Duration of pain = 7.3 yrs.
Treatment: Patients were randomized into 1 of 6 groups: 1) gabapentin-amitriptyline-diphenhydramine (GAD)(n=7), 2) GDA (n=6), 3) AGD (n=6), 4) ADG (n=6), 5) DGA (n=7), 6) DAG (n=6). Each drug was administered for 9 wks with 1 washout week before and after each drug treatment, for a total of 31 weeks. The maximum doses were 50mg, 3x/day for amitriptyline; 1200mg, 3x/day for gabapentin; 25mg, 3x/day, diphenhydramine (control).
Outcome Measures: Effectiveness of amitriptyline, diphenhydramine, gabapentin on pain management.

1. Amitriptyline was significantly more effective than diphenhydramine at 8 weeks, in subjects with high (≥ 10) baseline Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF) scores (p=0.035).
2. No significant difference was seen at 8 weeks in subjects with high (≥ 10) baseline CESD-SF scores in :
   1. Effectiveness of amitriptyline over gabapentin (p=0.061).
   2. Effectiveness of gabapentin over diphenhydramine (p=0.97).
3. Subjects with low (< 10) baseline CESD-SF scores showed no significant difference among the medications.

Cardenas et al. 2002; USA
PEDro=9
1 RCT
N=84

Population: Mean age = 41 yrs; Gender: males = 80%, females = 20%; Level of injury: cervical, lumbar; Severity of injury: AIS: A-D; Time since injury = 169 mths.
Treatment: Subjects with chronic pain randomized to a 6 wk course of amitriptyline or placebo 1-2 hrs before bedtime.
Outcome Measures: Average pain measure (scale 0-10), SF-MPQ, BPI, CES-D scale, FIM.

1. There were no significant differences between the 2 groups at baseline and at the 6 week time period for any of the measures except satisfaction with life which showed higher scores for those in the placebo group (p=0.004).
2. For those who remained on the two medications, it was noted that those in the amitriptyline group had significantly higher severity ratings for increased spasticity (p=0.005) than those in the control group.

Trazodone

Davidoff et al. 1987;
USA
PEDro=6
RCT
Initial N=19; Final N=18

Population: Mean age = 39 yrs; Gender: males = 16, females = 2; Time since injury = 49 mths.
Treatment: Subjects underwent a 2 week placebo lead-in period with a 6 week randomization to 150 mg trazodone per day or placebo.
Outcome Measures: MPQ, SPI, PAD

1. No significant differences were noted between the groups when looking at the MPQ, SPI, PAD.
2. More subjects reported side effects in the experimental gr (p<0.05).
3. More subjects in the placebo group completed the 8 wk study (p<0.01).