called tricyclic antidepressants. In low doses, antidepressants may
provide effective pain relief although they are not prescribed
specifically for co-morbid anxiety. (Anxiety and depression are not
symptoms of any disease, they are separate psychiatric disorders and
the diagnostic criteria of which is controversial particularly when
physical symptoms of underlying disease are mistaken for symptoms of
anxiety or depression).
Pain Med. 2011 Dec 5. doi: 10.1111/j.1526-4637.2011.01286.x. [Epub
ahead of print]
Effect of Low-Dose Amitriptyline on Autonomic Functions and Peripheral
Blood Flow in Fibromyalgia: A Pilot Study.
Kulshreshtha P, Gupta R, Yadav RK, Bijlani RL, Deepak KK.
Departments of Physiology Medicine, All India Institute of Medical
Sciences, New Delhi, India.
Abstract
Objective.=E2=80=82 Amitriptyline (10-50=E2=80=83mg) is the most common dru=
g
prescribed for the treatment of fibromyalgia. Amitriptyline influences
the autonomic nervous system, as is well known; fibromyalgia is also
associated with dysautonomia.
The present preliminary study was designed to observe the effects of
amitriptyline prescribed in a low dose (10mg) on the autonomic
function tests and blood flow measurements in well-diagnosed patients
with fibromyalgia.
Methodology.=E2=80=82 Amitriptyline (10=E2=80=83mg) was prescribed for 3 mo=
nths to 21
female patients with fibromyalgia. A standard battery of noninvasive
autonomic function tests comprising of lying to standing test, hand
grip test, cold pressor test, deep breathing test, and Valsalva
maneuver was performed both before and after amitriptyline therapy to
study the autonomic reactivity of the patients with fibromyalgia.
Heart rate variability analysis was done to quantify autonomic tone
(activity). Blood flow measurement around the knee joint was performed
using impedance plethysmography technique.
The patients were also assessed for 10 major clinical symptoms of
primary fibromyalgia and state and trait anxiety (state and trait
anxiety inventory) at both instances.
Results.=E2=80=82 No significant changes in autonomic activity (tone) and
reactivity were observed after amitriptyline therapy. Clinical symptom
score and anxiety scores (both state and trait) decreased
significantly from the pretreatment values. Blood flow measurement
showed significant improvement in blood flow index values at the
affected sites after amitriptyline therapy.
Conclusion.=E2=80=82 Amitriptyline therapy (10mg for 3 months) increases bl=
ood
flow to the affected sites. It does not affect autonomic tone and
reactivity in the patients with fibromyalgia.
Wiley Periodicals, Inc.
PMID: 22142408 [PubMed - as supplied by publisher]
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