Efficacy of amitriptyline and duloxetine in post-chikungunya neuropathic pain; a randomized, open-label, cross-over clinical trial
Abstract
Background: A significant number of chikungunya virus infected people develop neuropathic pain lasting for months to years. Patients with neuropathic pain are difficult to treat with conventional analgesics and frequently require antidepressant and anticonvulsant medications. The current study compared the efficacy of amitriptyline and duloxetine in the treatment of post-chikungunya neuropathic pain.
Methodology: In this randomized, cross-over, clinical trial, a total of forty patients were enrolled and randomly assigned to either amitriptyline or duloxetine for four weeks followed by a two-week washout period. Then the patients were crossed-over to the next phase which lasted for another four weeks. Amitriptyline was given in doses of 10, 25, and 50 mg and duloxetine was given in 20, 30, and 60 mg once daily at 8.00 PM respectively with optional dose up-titration. Pain relief was measured by VAS (visual analogue scale) after one, two, three, and four weeks in each phase as a primary outcome, and improvement of quality of life was assessed by SF-36 (short form-36) at the beginning and end of each phase as a secondary outcome.
Results: A total of twenty one patients completed both treatment phases out of forty patients. The reduction of pain intensity was significant in both amitriptyline and duloxetine groups compared with their baseline values (p < 0.001), with no significant difference between the groups (p > 0.336). The quality of life (SF-36) was significantly improved with both amitriptyline and duloxetine (p < 0.001) but the difference between the two treatments was not significant (p > 0.324). Regarding adverse events, dry mouth was significantly more common in the amitriptyline group than the duloxetine group (p < 0.013).
Conclusion: Amitriptyline and duloxetine can be used in the treatment of post-chikungunya neuropathic pain effectively, but duloxetine is preferred because of its less adverse effects.
Trial registration: The trial was approved by Institutional Review Board, Bangabandhu Sheikh Mujib Medical University dated January 19, 2020; Trial number: BSMMU/2020/712.
Key words: Chikungunya; Neuropathic pain; Quality of life; Amitriptyline; Duloxetine; DN4; SF-36
Abbreviations: VAS – Visual analogue scale, NSAIDs – Non-steroidal anti-inflammatory drugs, DMARD – Disease-modifying anti-rheumatic drugs, TCA – tricyclic antidepressants, NICE – National Institute for Health and Care Excellence, SNRI – Serotonin noradrenaline reuptake inhibitor
Citation: Kamal MM, Rahman MM, Sharmin S, Bhowmick DK, Islam MS, Akhtaruzzaman AKM. Efficacy of amitriptyline and duloxetine in post-chikungunya neuropathic pain; a randomized, open-label, cross-over clinical trial. Anaesth. pain intensive care 2021;25(5):647–652; DOI: 10.35975/apic.v25i5.1634
Received: May 02, 2021, Reviewed: July 17, 2021, Accepted: July 20, 2021
