Amitriptyline Effect on Tumor Necrosis Factor-a, Interleukin-1 and Interleukin-6 Serum Level and its Correlation with Pain Severity in Chronic Tension-Type Headache Patients
Rambe, Aldy Safruddin
Machfoed, Moh Hasan
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Introduction : Chronic tension-type headache (CTTH) differs from the episodic form not only in frequency but also with respect to pathophysiology, lack of effect to most treatment strategies, frequent medication overuse, more disability, and higher socioeconomic costs. The purpose of this study is to see the effect of amitriptyline on TNF-a, IL-1, and IL-6 serum levels in CTTH patients and its correlation with pain severity. Method : This research was done at the Adam Malik Hospital and Bukit Barisan Army Hospital Medan, Indonesia from January 2013 - June 2014 and approved by the Ethics Committee for Health Research School of Medicine in University of Sumatera Utara. The subjects were recruited consecutively from study population. Diagnosis of CTTH was based on the diagnostic criteria as stated in the ICH X. We assessed pain severity by using the Numeric Rating Scale ( NRS ) for pain. Venous blood was taken to measure serum levels of TNF-a , IL-1, and IL-6. After subjetcs were given amitriptyline 25 mg once daily in the evening for ten days, NRS scores were reassessed and the second measurements of these cytokines serum level were done. Results : Twenty three subjects, 5 male and 18 female participated in this study. There was a significant difference (p=0.001) between baseline NRS score (4.52 ± 1.78) with NRS score after amitriptyline administration (1.87 ± 1.10). No significant difference (p=0.051) was found between baseline TNF-a (2.15 ± 0.98 pg/dl) with TNF-a level after treatment (1.89 ± 0.86 pg/dl). There was no significant difference between baseline and after 10-day amitriptyline dosage for IL-1 serum level (0.24 ± 0.26 pg/dl vs 0.25 ± 0.22 pg/dl, p=0.954) nor IL-6 serum level (1.84 ± 1.36 pg/dl vs 2.01 ± 1.76 pg/dl, p=0.687). There was a very weak negative (R=-0.178) non significant correlation (p=0.415) between NRS score and TNF-a serum level. In these subjects, we found a very weak negative (R=-0.111) non significant correlation (p=0.615) between NRS score and IL-1 serum level. NRS score and IL-6 serum level had a weak (R=-0.364) non significant negative correlation (p=0.088) Conclusions : Amitriptyline decreased serum level of TNF-a but not statistically significant. Amitriptyline had no effect on IL-1 nor IL-6 serum levels. Amitiriptiline lowered pain intensity based on NRS score (p=0.001). NRS score and TNF-a serum level had a very weak and non significant negative correlation. NRS score and IL-1 serum level had a very weak and non significant negative correlation, while NRS score and IL-6 serum level had a weak and non significant negative correlation.