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A Randomized Controlled Trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and surrogate placebo in the treatment of chronic tension-type facial pain

Patients often present to otolaryngologists with chronic facial pain, presumed to be of sinus origin despite normal nasal endoscopy and sinus CT. This pain has increasingly been recognized as being of neurological origin with one of the commonest underlying causes being mid-facial segmental tension-type pain (MFP) which is a version of tension-type headache affecting the mid-face.

Rhinology 2013; 51: 143-153

Agius AM1, Jones NS2, Muscat R3

  1. The Medical School, University of Malta, Msida, Malta
  2. Department of Otolaryngology, University of Nottingham, United Kingdom
  3. Department of Physiology and Biochemistry, University of Malta

 

Summary

Patients often present to otolaryngologists with chronic facial pain, presumed to be of sinus origin despite normal nasal endoscopy and sinus CT. This pain has increasingly been recognized as being of neurological origin with one of the commonest underlying causes being mid-facial segmental tension-type pain (MFP) which is a version of tension-type headache affecting the mid-face.

Objectives:

Primary Outcome Measures:  1. To determine whether low-dose amitriptyline reduces pain scores compared to surrogate placebo in patients with chronic MFP.  2. To determine whether the addition of pindolol, a beta blocker with serotonin receptor blocking properties hastens onset of action or improves efficacy of amitriptyline. Secondary outcome measure: to determine whether amitriptyline or amitriptyline with pindolol significantly reduces analgesic consumption.

Setting: An otolaryngological practice on a Mediterranean island.

Study Design  Randomised single-blind study with parallel design

Method: Sixty two patients were randomized to three treatment groups (a) amitriptyline 10mg daily (b) amitriptyline 10mg daily with pindolol 5mg twice daily and (c) loratadine 10mg daily. Daily pain scores using a facial pain diary were recorded over eight weeks.

Results: At 8 weeks, pain frequency and intensity were significantly reduced in patients treated with amitriptyline and in those receiving amitriptyline with pindolol compared to surrogate placebo. Patients on the combination therapy showed significantly improved clinical outcome and significantly reduced analgesic intake compared to those on amitriptyline alone.

 

Conclusion: Low dose amitriptyline is effective in the management of MFP and is enhanced by the addition of pindolol.

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