A medication commonly prescribed to treat depression may help reduce spontaneous pain in patients with chronic temporomandibular disorders (TMDs), according to a new study published on March 4 in BMC Oral Health.
After taking low-dose amitriptyline for two months, patients experienced less pain and improved quality of life, the authors wrote.
"This study highlights low-dose amitriptyline as an effective treatment for chronic TMD," wrote the authors, led by Ivan Brakus of the University of Split School of Medicine in Croatia.
Due to the multifaceted nature of TMDs, therapies focus on relieving pain and restoring temporomandibular joint function, which in turn improves an individual's overall quality of life. Though treatments, including mouthguards, exercises, and cognitive behavioral therapy, have been explored, pharmacological interventions are of particular interest. Medications regulate complex neurochemical pathways related to constant pain.
Extensive studies have been done to evaluate amitriptyline for off-label use in managing chronic pain conditions, including orofacial pain syndromes. The antidepressant's analgesic effects are believed to stem from its inhibition of serotonin and norepinephrine reuptake, which among other things, regulates descending pain pathways. However, the existing studies remain moderate to low in quality.
To measure the effectiveness of low-dose amitriptyline in decreasing pain and improving oral health-related quality of life in individuals with chronic TMDs, 40 people were selected to take either 25 mg of the antidepressant or a placebo pill for two months. Pain was measured using a visual analog scale (VAS), and the Oral Health Impact Profile questionnaire was conducted at baseline and after the first and second months of treatment to assess participants' oral health quality of life, according to the study.
After two months of treatment, those taking amitriptyline experienced a considerably greater reduction in spontaneous pain, with an approximately 63% decrease in VAS scores. On the flip side, those who took placebos saw a much smaller decrease in pain, a nearly 16% drop in VAS scores, the authors wrote.
Also, the patients who took antidepressants saw a much greater improvement in oral health quality of life (p < 0.001). In the placebo group, they showed no significant change in oral health-related quality of life (p = 0.184), they wrote.
Nevertheless, the study had limitations. There was no sex matching between the placebo and amitriptyline groups, which has the potential to introduce bias. However, there were no notable differences between the men and women in this study, the authors wrote.
"Given the complex interplay of genetic, psychological, and environmental factors in chronic pain syndromes, continued efforts to optimize treatment strategies and personalize care for individuals suffering from TMD and related conditions remain essential," Brakus and colleagues wrote.
