Nortriptyline Compared to Amitriptyline for the Treatment of Persistent Masticatory Myofascial Pain

Aims: To evaluate and compare the pharmacotherapeutic efficacies of two tricyclic antidepressant (TCA) drugs for masticatory myofascial pain (MFP): nortriptyline (NOR) and amitriptyline (AMI). Methods: Fifty patients with chronic MFP were included in the study; 30 were medicated with AMI only, and 20 took NOR after discontinuing AMI due to adverse effects. Pain diaries recording verbal pain scores (VPS) were utilized to compare posttreatment scores to baseline scores. Chi-square and t tests were used to analyze the data. Results: Across both groups, the mean ± standard deviation VPS score at the end of treatment (2.92 ± 3.2) was significantly lower compared to baseline (6.4 ± 1.75; P .0001) and was a clinically meaningful (≥ 50%) difference. Initial VPS scores were similar in the AMI and NOR groups (6.27 ± 1.92 and 6.78 ± 1.98). At the end of the study, NOR patients reported a lower final VPS compared to AMI patients (2.83 ± 3.06 vs 4.55 ± 2.92; P = .039). The 50% improvement rate with NOR treatment was better than with AMI treatment (P = .036). The same maximal dosages were used by the patients who achieved a ≥ 50% success rate (20.96 ± 5.036 mg) than those who did not (21.667 ± 5.036 mg). Conclusion: TCAs are effective in reducing pain in patients with chronic MFP. NOR seems more effective and better tolerated than AMI, but due to study limitations, more data are needed to confirm these results. Keywords: amitriptyline, myalgia, myofascial pain, orofacial pain