Published online Mar 20, 2026. doi: 10.5662/wjm.v16.i1.107203
Revised: May 15, 2025
Accepted: August 15, 2025
Published online: March 20, 2026
Processing time: 329 Days and 21.1 Hours
Chronic nonspecific low back pain is defined as pain that persists for greater than 12 weeks and mainly occurs in the lower back with no evidence of associated underlying serious conditions [like malignancy, inflammation (like ankylosing spondylitis) or infection, vertebral fracture, etc.].
To compare the efficacy and safety of amitriptyline with duloxetine in treating chronic low back pain (CLBP).
The present study was a two-arm observational study conducted over 18 months in a tertiary rehabilitation setting. A total of 254 patients were included in the study.
The mean age was significantly higher in the amitriptyline group (34.78 ± 8.22 years) compared with the duloxetine group (29.98 ± 7.28 years, P < 0.0001). Baseline visual analog scale (VAS) scores were also significantly different between groups (amitriptyline: 7.92 ± 0.56; duloxetine: 8.46 ± 0.79; P < 0.0001). Within-group analysis showed a significant reduction in VAS scores over time in both groups (P < 0.001). At 12 weeks the duloxetine group showed significantly lower VAS scores (0.92 ± 0.78) compared with the amitriptyline group (1.87 ± 1.71; P < 0.0001). Analysis of variance, adjusting for age and baseline VAS, confirmed a significant group effect on pain reduction at 12 weeks (P < 0.001), favoring duloxetine. Side effects were generally mild. The most common in the amitrip
Amitriptyline and duloxetine effectively treat CLBP; however, considering side effects and more sustained pain relief, duloxetine appears to be the better option. Nonetheless, treatment choice should consider individual patient profiles.
Core Tip: This study compared the efficacy and safety of amitriptyline and duloxetine in treating chronic low back pain. Both medications were effective in reducing pain as evidenced by statistically significant improvements in the visual analog scale at 1 week, 4 weeks, and 12 weeks. However, duloxetine demonstrated a more favorable side effect profile and better long-term sustained effects with fewer anticholinergic and sedative effects compared with amitriptyline. These findings suggest that while both drugs are viable options for chronic low back pain management, duloxetine may be preferred for patients seeking a treatment with fewer side effects. The choice of medication should be individualized based on patient-specific factors and health conditions.