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Final Program


Final Congress Guide

Therapeutics

1000 Section - Amitriptyline use and dysautonomia assessment in the early management of suspected Fibromyalgia

Wednesday, May 20, 2026
6:00 PM - 7:30 PM PT

    Presenting Author/Autor expositor(s)

  • SG

    Sabri Garoushi, MD

    Rehabilitation Medicine Resident ST6
    Leeds Teaching Hospitals Trust
    Leeds, England, United Kingdom

    • Co-Author/Coautor(s)

  • Manoj Sivan, MD FRCP

    Clinical Professor in Physical and Rehabilitation Medicine at University of Leeds & Leeds NHS Trusts
    University of Leeds and Leeds Teaching Hospitals NHS Trust
    Leeds, England, United Kingdom

  • KM

    Khaled Mahmoud, MD

    Rheumatology Registrar ST6
    Leeds Teaching Hospitals Trust
    Leeds, England, United Kingdom

Objectives : Fibromyalgia (FM) is a prevalent chronic pain condition frequently referred to Rheumatology for diagnostic clarification. Patients often present with widespread pain, fatigue, sleep disturbance, and symptoms of autonomic dysfunction such as orthostatic intolerance or palpitations. Amitriptyline is widely used for fibromyalgia pain and sleep but can exacerbate symptoms in those with dysautonomia or postural orthostatic tachycardia syndrome (PoTS). The purpose of this study was to evaluate referral patterns, management strategies (particularly Amitriptyline use), and the documentation of dysautonomia assessment in patients referred with suspected fibromyalgia.

Design:

Study Type: Retrospective review under a Quality Improvement framework.

 

Setting: Rheumatology clinics, Leeds Teaching Hospitals NHS Trust, UK.

 

Sample: 39 referrals.

 

Data Collected: Demographics, referral source, mental health comorbidity, medications started (Amitriptyline and others), physiotherapy referral, ECG completion, and 10-min Lean Test/dysautonomia documentation.

 

Analysis: Data extracted from clinic records and referral letters (2024–2025). Descriptive analysis conducted using Microsoft Excel.

Results:

• Total patients: 39
• Median age (IQR): 48 years (40–58)
• Gender: 35 Female, 4 Male
• Referral source: GP 20 (51%), Hospital 19 (49%)
• Mental health problems documented: 64.1%
• Started Amitriptyline: 20/39 (51.3%)
• Other medications: Gabapentin (17), Pregabalin (4), Tramadol (3), Duloxetine (2), Fluoxetine (1)
• Physiotherapy referral: 53.8%
• ECG completed: 17.9%
• NASA Lean recorded: 100% (39/39), but no HR/BP values or explicit dysautonomia documentation.

Key Observations:Amitriptyline initiated in over half of cohort. Lean test lacked some values and ECG completion prior to TCA initiation was low.

Conclusion:

 

Amitriptyline remains the most commonly initiated treatment in suspected fibromyalgia, despite the absence of structured dysautonomia assessment. 10-min Lean documentation was universal but lacked quantitative data, suggesting a need for structured forms. Low ECG completion rates highlight a safety gap before tricyclic initiation. Findings support a service redesign focusing on safe prescribing, standardized orthostatic assessment, and improved integration of non-pharmacological management.