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.