Therapy with amitriptyline or physiotherapy is equally effective in fibromyalgia!!!

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You can learn about fibromyalgia from this blog site by typing “fibromyalgia” in the search box of this blog site. The search box is at top left of this page.

In an rural set up Indian study, first of it’s kind, comparing the effect of amitriptyline or physiotherapy in improving outcome in patients of fibromyalgia over a period of six months, Joshi et al found they are equally effective.

Usually fibromyalgia is treated by: antidepressants, analgesics, exercise, cognitive behavioral therapy.

1. Therapeutic Drugs used in fibromyalgia: amitryptiline and other tricyclic antidepressants, pregabalin, duloxetine and milnacipran.
2. Physiotherapy in fibromyalgia: Exercise in the form of cardiovascular training, strength training, aerobics, flexibility training, all can lead to improvement in fibromyalgia.

Joshi employed a trained physiotherapist to conduct a uniform structured physical training and aerobic session for patients in physiotherapy treatment group. The patients were advised to perform the exercises daily twice for at least 10 min. Further there was a step-up pattern of exercise regimen followed by relaxation, stretching and strengthening techniques.

In this experiment physiotherapy was compared with following dosage of amitriptyline.

Amitriptyline dose was 25 mg to 50 mg. No patient required further escalation of doses. All patients were also offered pharmacologic treatment with 50 mg tramadol in thrice daily doses and as required.

Reference: Joshi MN, Joshi R, Jain AP. Effect of amitriptyline vs. physiotherapy in management of fibromyalgia syndrome: What predicts a clinical benefit?. J Postgrad Med [serial online] 2009 [cited 2009 Nov 30];55:185-9. Available from: http://www.jpgmonline.com/text.asp?2009/55/3/185/57399

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