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Tricyclic
antidepressants are found to be effective in managing chronic masticatory myofascial pain. Nortriptyline holds greater efficacy and
tolerability than amitriptyline in alleviating masticatory myofascial pain.
As per a study published in the Journal of Oral & Facial Pain and Headache, the tricyclic
antidepressants (TCA) especially Nortriptyline (NOR), proved to be effective
and well tolerated in masticatory myofascial pain (MFP). MFP is the is one of
the temporomandibular disorders, characterised by moderate pain with inability
in mandibular movement. Due to the understanding of various factors like
physiological, biochemical and physical to the origin and evolution of the
disease, many approaches such as NSAIDs, Opioids, TCAs etc. were proposed for
the investigations. To manage myofascial pain, TCAs are the most investigated
approach. The study aimed to conduct a comparative analysis of two TCAs;
amitriptyline (AMI) and nortriptyline (NOR) efficacies for MFP. A total of 50
patients selected; 20 underwent NOR after AMI discontinuation and 30 underwent
AMI only. The baseline to posttreatment scores were compared via pain diaries
which recording verbal pain scores (VPS). Data was analysed through t- and
chi-square tests.
As compared to
baseline, both groups showed a significant clinically meaningful (≥ 50%)
difference and lowered mean ± standard deviation VPS scores (6.4 ± 1.75 and
2.92 ± 3.2, respectively, P < .0001). Both groups exhibited similar initial
VPS scores, but at the end, NOR group reported considerably lowered VPS scores
as compared to AMI group (P = .039). Also, the NOR group exhibited better 50%
improvement rate than AMI (P = .036). These patients achieved a ≥ 50% success
rate than those who did not use the same maximal dosages. The results confirmed
the effectiveness of TCAs in managing chronic MFP.
Journal of Oral & Facial Pain and Headache
Nortriptyline Compared to Amitriptyline for the Treatment of Persistent Masticatory Myofascial Pain.
Yaron Haviv et al.
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