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Does
this data suggest that amitriptyline doses approaching 150
mg are optimal for pain relief?
You
answered:
This
data does not suggest the amitriptyline doses are optimal.
CORRECT
Even
apart from the fact that there are too few points at the
higher dose levels for statistical significance, individual
titration designs have historically tended to give gross
overestimates of effective dose levels. If a given dose
produces an increasing effect over time, for example, it
may appear that continued dose escalation is causing the
improvement, when patients would have had similar improvement
if they had stayed at a fixed low dose. For example, the
recommended doses of many antihypertensives developed in
the 1970’s were as much as ten times the true optimal level
established by later studies in which patients were prospectively
assigned to specific doses (Temple,
1989).
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