Editing Amitriptyline (section)

===Pain===
Amitriptyline alleviates painful [[diabetic neuropathy]]. It is recommended by a variety of guidelines as a first or second-line treatment.<ref name="pmid32040849">{{cite journal | vauthors = Alam U, Sloan G, Tesfaye S | title = Treating Pain in Diabetic Neuropathy: Current and Developmental Drugs | journal = Drugs | volume = 80 | issue = 4 | pages = 363–384 | date = March 2020 | pmid = 32040849 | doi = 10.1007/s40265-020-01259-2 | s2cid = 211074023 }}</ref> It is as effective for this indication as [[gabapentin]] or [[pregabalin]] but less well tolerated.<ref name="pmid33145709">{{cite journal | vauthors = Liampas A, Rekatsina M, Vadalouca A, Paladini A, Varrassi G, Zis P | title = Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review | journal = Pain and Therapy | volume = 10 | issue = 1 | pages = 55–68 | date = June 2021 | pmid = 33145709 | pmc = 8119529 | doi = 10.1007/s40122-020-00210-3 | doi-access = free }}</ref> Amitriptyline is as effective at relieving pain as [[duloxetine]]. [[Combination therapy|Combination treatment]] of amitriptyline and pregabalin offers additional pain relief for people whose pain is not adequately controlled with one medication and is usually safe.<ref>{{cite journal |date=6 April 2023 |title=Combination therapy for painful diabetic neuropathy is safe and effective |url=https://evidence.nihr.ac.uk/alert/combination-therapy-for-painful-diabetic-neuropathy-is-safe-and-effective/ |journal=NIHR Evidence |language=en |doi=10.3310/nihrevidence_57470 |s2cid=258013544 |access-date=28 April 2023 |archive-date=28 April 2023 |archive-url=https://web.archive.org/web/20230428104720/https://evidence.nihr.ac.uk/alert/combination-therapy-for-painful-diabetic-neuropathy-is-safe-and-effective/ |url-status=live |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Julious S, Rajbhandari S, Sharma S, Rayman G, Gouni R, Alam U, Cooper C, Loban A, Sutherland K, Glover R, Waterhouse S, Turton E, Horspool M, Gandhi R, Maguire D, Jude EB, Ahmed SH, Vas P, Hariman C, McDougall C, Devers M, Tsatlidis V, Johnson M, Rice AS, Bouhassira D, Bennett DL, Selvarajah D | title = Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial | journal = Lancet | volume = 400 | issue = 10353 | pages = 680–690 | date = August 2022 | pmid = 36007534 | pmc = 9418415 | doi = 10.1016/s0140-6736(22)01472-6 }}</ref> Amitriptyline in certain formulations may also induce the level of [[sciatic]]-nerve blockade needed for local [[anesthesia]] therein.<ref name="pmid12749958">{{cite journal | vauthors = Sudoh Y, Cahoon EE, Gerner P, Wang GK | title = Tricyclic antidepressants as long-acting local anesthetics | journal = Pain | volume = 103 | issue = 1–2 | pages = 49–55 | date = May 2003 | pmid = 12749958 | doi = 10.1016/s0304-3959(02)00375-5 | s2cid = 24955042 }}</ref> Here, it has been demonstrated to be of superior potency to [[bupivacaine]], a customary long-acting local anesthetic.

Low doses of amitriptyline moderately improve sleep disturbances and reduce pain and fatigue associated with [[fibromyalgia]].<ref name="pmid28493231" /> It is recommended for fibromyalgia accompanied by depression by [[Association of the Scientific Medical Societies in Germany]]<ref name="pmid28493231">{{cite journal | vauthors = Sommer C, Alten R, Bär KJ, Bernateck M, Brückle W, Friedel E, Henningsen P, Petzke F, Tölle T, Üçeyler N, Winkelmann A, Häuser W | title = [Drug therapy of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles] | language = de | journal = Schmerz | volume = 31 | issue = 3 | pages = 274–284 | date = June 2017 | pmid = 28493231 | doi = 10.1007/s00482-017-0207-0 | s2cid = 195671256 }}</ref> and as a second-line option for fibromyalgia, with exercise being the first line option, by [[European League Against Rheumatism]].<ref name="pmid27377815">{{cite journal | vauthors = Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, Choy E, Kosek E, Amris K, Branco J, Dincer F, Leino-Arjas P, Longley K, McCarthy GM, Makri S, Perrot S, Sarzi-Puttini P, Taylor A, Jones GT | title = EULAR revised recommendations for the management of fibromyalgia | journal = Annals of the Rheumatic Diseases | volume = 76 | issue = 2 | pages = 318–328 | date = February 2017 | pmid = 27377815 | doi = 10.1136/annrheumdis-2016-209724 | hdl-access = free | doi-access = free | hdl = 2164/8814 }}</ref> Combinations of amitriptyline and [[fluoxetine]] or [[melatonin]] may reduce fibromyalgia pain better than either medication alone.<ref name="pmid29457627">{{cite journal | vauthors = Thorpe J, Shum B, Moore RA, Wiffen PJ, Gilron I | title = Combination pharmacotherapy for the treatment of fibromyalgia in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | pages = CD010585 | date = February 2018 | pmid = 29457627 | pmc = 6491103 | doi = 10.1002/14651858.CD010585.pub2 }}</ref>

There is some (low-quality) evidence that amitriptyline may reduce pain in cancer patients. It is recommended only as a second-line therapy for non-chemotherapy-induced neuropathic or mixed neuropathic pain if [[opioid]]s did not provide the desired effect.<ref name="pmid27207115">{{cite journal | vauthors = van den Beuken-van Everdingen MH, de Graeff A, Jongen JL, Dijkstra D, Mostovaya I, Vissers KC | title = Pharmacological Treatment of Pain in Cancer Patients: The Role of Adjuvant Analgesics, a Systematic Review | journal = Pain Practice | volume = 17 | issue = 3 | pages = 409–419 | date = March 2017 | pmid = 27207115 | doi = 10.1111/papr.12459 | s2cid = 37418010 }}</ref>

Moderate evidence exists in favor of amitriptyline use for [[atypical facial pain]].<ref name="pmid33037835">{{cite journal | vauthors = Do TM, Unis GD, Kattar N, Ananth A, McCoul ED | title = Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta-Analysis | journal = The Laryngoscope | volume = 131 | issue = 6 | pages = 1235–1253 | date = June 2021 | pmid = 33037835 | doi = 10.1002/lary.29162 | s2cid = 222256076 }}</ref> Amitriptyline is ineffective for HIV-associated neuropathy.<ref name="pmid33145709"/>

In multiple sclerosis, it is frequently used to treat painful paresthesias in the arms and legs (e.g., burning sensations, pins and needles, stabbing pains) caused by damage to the pain-regulating pathways of the brain and spinal cord.<ref>{{cite web |title=Elavil for MS |url=https://www.nationalmssociety.org/Treating-MS/Medications/Elavil |access-date=7 July 2023 |website=nationalmssociety.org |archive-date=7 July 2023 |archive-url=https://web.archive.org/web/20230707205228/https://www.nationalmssociety.org/Treating-MS/Medications/Elavil |url-status=dead }}</ref>