1346 - The Impact of Neuropathic Agents on Opioid Burden During Inpatient Traumatic Brain Injury Rehabilitation: A Retrospective Study

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

LT

Lauren Truong, DO

Resident Physician
Loma Linda University
Rancho Cucamonga, California, United States

Presenting Author(s)

RL

Ryan Leung, DO

Resident
Loma Linda University
Rancho Cucamonga, California, United States

Co-Author(s)

CL

Collin Lee, MD

Resident Physician
Loma Linda University
Redlands, California, United States
KC

Ken Cautivar, BS

Student Physician
Loma Linda University School of Medicine
Loma Linda, California, United States
DT

Duc Tran, MD

Associate Professor
Loma Linda University Medical
Loma Linda, California, United States
EP

Eugene Pak, MD

MD
Loma Linda University
Loma Linda, California, United States

Submitter(s)

LT

Lauren Truong, DO

Loma Linda University
Rancho Cucamonga, California, United States

Objectives: Pain management during traumatic brain injury (TBI) rehabilitation is critical for recovery, yet opioid use carries significant risks. While some non-opioid analgesics have been associated with reduced opioid consumption, the role of neuropathic agents (e.g., tricyclic antidepressants, gabapentinoids, SNRIs) specifically for TBI-related pain is not well characterized. This study evaluates whether the use of amitriptyline, nortriptyline, pregabalin, or duloxetine is associated with a reduction in total opioid burden during inpatient TBI rehabilitation.

Design: A retrospective chart review was conducted on adults >18 years old admitted for primary TBI rehabilitation between January 2020 and June 2025. Patients with multiple trauma or who received no opioids during admission were excluded, yielding 155 patients. Data extracted included daily morphine milligram equivalents (MME) and dosing of target neuropathic agents. The primary outcome was the change in MME from admission to discharge (DeltaMME). Analyses included two-tailed t-tests and multiple linear regression.

Results: The use of amitriptyline and nortriptyline was associated with a statistically significantly greater reduction in opioid consumption. Patients on amitriptyline had a mean DeltaMME of -27.5 compared to -9.1 in those not on it (p=0.0082). Patients on nortriptyline had a mean DeltaMME of -30.5 compared to -9.5 in those not on it (p=0.0081). Regression analysis confirmed a significant inverse relationship, where higher total doses of amitriptyline (p=0.005) and nortriptyline (p=0.007) were correlated with larger reductions in MME.

Conclusions: The initiation of amitriptyline or nortriptyline during inpatient TBI rehabilitation is significantly correlated with a reduction in total opioid consumption. This suggests that these neuropathic agents may be effective opioid-sparing adjuvants for pain management in this population. Implementing a multimodal pain regimen incorporating these medications could help reduce opioid dependence and improve rehabilitation outcomes. Further prospective studies are warranted to confirm these findings and establish optimal dosing protocols.