Treatment Database

A tricyclic antidepressant (TCA) widely used at low doses (10–50 mg at night) for fibromyalgia pain, non-restorative sleep, and comorbid ME/CFS symptoms. A Cochrane review found amitriptyline provides clinically useful pain relief in a minority of fibromyalgia patients (9 trials, 649 participants; NNT about 4 for at least 50% pain relief), but rated the evidence very low quality, found no consistent benefit over placebo for fatigue, sleep or quality of life, and found more side effects (78% vs 47%). It is not a first-line agent by rigorous RCT standards but remains a mainstay of clinical practice for pain-sleep overlap. Also used off-label for IBS, migraine prophylaxis, and neuropathic pain.