Clomipramine (Anafranil) and musculo-skeletal pain in general practice: a pilot, open, non-comparative study of long-standing rheumatic pain.

Forty-six patients were admitted to an open general practice study of clomipramine (Anafranil) in the treatment of long-standing rheumatic pain; forty-one patients completed the trial. The duration of the trial was 56 days during which patients received daily doses of either 10 mg or 25 mg of clomipramine. Assessments were made at fortnightly intervals. Patients were assessed for pain using a visual analogue scale, analgesic requirement, joint pain, other pain and morning stiffness. At the completion of the study patients were asked whether the addition of clomipramine to their treatment was better, the same or worse than no additional treatment. Twenty-one patients (57%) felt that it was better, four felt that it was the same and twelve said that it was worse. The doctor also similarly recorded his preference at the end of the trial. In twenty-two cases (60%) the doctor felt it was better, in eight that there was no difference and in seven that it was worse. There was no difference between the 10 mg and the 25 mg regime. It is suggested that better control of rheumatic symptoms can be achieved in some patients by the addition of small daily doses of clomipramine to their standard anti-rheumatic therapy. The author expresses the view that further research in this field is merited.