Taking Elavil for Chronic Back Pain


Elavil, aka, Amitriptyline, is sometimes given as an adjuvant pain medication to people with chronic back pain.  

What Is Amitriptyline?

Diagram of an amitriptyline molecule.
Amitriptyline Molecule. Laguna Design/Science Photo Library/Getty Images.

Amitriptyline is the generic name for an antidepressant medication sometimes prescribed off-label to manage chronic back pain. Tricyclic antidepressants, including amitriptyline, is a drug class in a category known as adjuvant pain medications.

In the U.S., the brand name for amitriptyline is Elavil.

Elavil or Amitriptyline is generally tried when conservative treatments, including medications such as NSAIDs and Tylenol, have not been effective for relieving the pain.

Elavil is not a narcotic (i.e. opioid) drug.

What Type of Back Pain Does Amitriptyline Treat?

A gowned woman sits at the end of an examining table in a doctor's office.
Pain management medicine for the relieve of chronic neck or back pain is a team project. H. Armstrong Roberts/Classic Stock Archive Photos/Getty Images

Elavil is effective for neuropathic type of chronic back pain. For spine pain sufferers, this usually means your pain radiates down an arm or leg.

Although Elavil's pain relieving abilities are independent of its antidepressant effect, the drug works by increasing the amount of certain brain chemicals necessary for mental balance.

Amitriptyline is also used to treat fibromyalgia, which is a condition marked by widespread pain and tender points.


Is Amitriptyline Effective?

Doctor with Stethoscope is Reading Package Insert
Tomas Rodriguez / Getty Images

Amitriptyline is the most studied of all the tricyclic antidepressants. It has been in use since the 1960s.

According to Dr. Kathleen Fink, Director of Pain Services at the National Rehabilitation Hospital in Washington D.C., this medication is underutilized due to the development of newer tricyclic antidepressants.

Fink says doctors are not comfortable prescribing amitriptyline for chronic spine pain because the side effects can make you feel hung over in the morning. "But in reality," she says, "amitriptyline is an effective and inexpensive medication for managing chronic back pain, especially if you are also having problems sleeping."

A 2014 study published in the Journal of Neurological Science compared amitriptyline with pregabalin (another drug given for neuropathic pain) for reducing pain, as well as physical disability.  The researchers found that while both were effective pain relievers, only amitriptyline significantly reduced disability, as well.

Amitriptyline Dosage

Close up of oval white pill
Close up of oval white pill. GIPhotoStock / Getty Images

When Elavil is used for managing back or neck pain, the dose is lower (approximately half, although this will vary) than when it is taken for depression.

Your doctor will likely start you at a very low dose and then increase upwards a little each week until your pain is relieved and/or the side effects become too much for you.

Positive effects often occur more speedily when this drug is taken for chronic back pain (as compared to when it is used for managing depression.)


Amitriptyline Side Effects

Woman holding medication

Because amitriptyline is approved by the FDA to treat depression, it can affect mental status, including increasing the risk for suicide. But on the scale of things, amitriptyline likely has a relatively low risk of suicide.

For example, 2015 cohort study published in the British Medical Journal found that in people with depression, the absolute risk of suicide for amitriptyline over one year was 0.02% while for mirtazapine, it was 0.19%.  

If you are pregnant or breastfeeding, it's best to stay away from amitriptyline or Elavil, because the drug could possibly be passed on to your child.

Elavil can cause problems for people who have arrhythmia and other forms of heart disease, and it is not generally given to people over the age of 60. (The newer antidepressants may be a better choice for this age group.)

A few less serious Elavil side effects include dry mouth and drowsiness.


Amitriptyline and Drug Interactions

Prescriptions and drugs with water.
Gerard Fritz / Getty Images

Interactions between Elavil and other drugs you may be taking can increase the amount of amitriptyline in your blood. In turn, this may increase side effects of the medication.

Other types of drug interactions are possible, as well. Therefore, it is important to tell your doctor everything you are taking, whether recreational, over-the-counter or prescribed.

For example, if you take St. John's Wort, an herbal medication sometimes used for depression, you may run the risk of a drug interaction between it and the Elavil you take.

Birth control pills and hormone therapy are further examples of substances that could cause problems when mixed with Elavil.


When to Avoid Amitriptyline - Contraindications

Doctor and patient conversation
Doctor and patient conversation. Dan Dalton/Caiaimage/Getty Images

There are some instances in which it is best to avoid taking amitriptyline altogether.

For example, if you are taking MAO inhibitors (for depression or similar condition) or the heartburn medication cisapride (which has been discontinued in the U.S.) do not begin taking amitriptyline.

Always discuss your other health conditions and any drugs you may be taking with your doctor before taking amitriptyline, and follow her advice to the letter.

Stopping or switching medications also requires the expert guidance of your doctor. 

Further reading: Elavil Contraindications



Architectural view of a big library with lots of books.
Architectural view of a big library with lots of books. Carl Bruemmer / Design Pics/Perspective/Getty Images

Coupland C., et. al. Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database. BMJ. Feb. 2015. Accessed: April 2016. http://www.ncbi.nlm.nih.gov/pubmed/25693810

Fink, K., M.D. Telephone Interview. National Rehabilitation Hospital. May 2011.

Kalita J., et. al. An open labeled randomized controlled trial of pregabalin versus amitriptyline in chronic low backache. J Neurol Sci. July 2014. Accessed: April 2016. http://www.ncbi.nlm.nih.gov/pubmed/24857356

Continue Reading