Anti-depressants as treatment for pain?

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Coats - 18 Nov 2006 19:16 GMT

Went back to my GP after the rheumatologist said he wouldn't do
anything...long story. After telling the new (to me) GP that I'm up to 800mg
of ibuprofen a time and the odd co-codamol a few times a day to control my
shoulder, wrist and knuckle/finger pain she has prescribed Amitriptyline for
me to take at night. Her reason that it has been used before to control
acute pain and may work for me. I'm starting on 10mg a night and if it help
with my pain overnight and upon waking then she will see if there's
something I can take in the daytime.
I'm a little concerned about the side effects though. I had a problem with
Voltarol (diclofenac) giving me palpitations, shortness of breath and
headaches and am worried that this will be worse, especially as it seems to
be one of the addictive sorts of anti-depressant.
Anyone had this sort of treatment and if so did it work?

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Splodge - 18 Nov 2006 22:51 GMT

> Went back to my GP after the rheumatologist said he wouldn't do
> anything...long story. After telling the new (to me) GP that I'm up to
[quoted text clipped - 9 lines]
> to be one of the addictive sorts of anti-depressant.
> Anyone had this sort of treatment and if so did it work?

Amitriptyline was originally recommended by my doctor as I was unable to get
a decent nights sleep. Is that your problem Cathy? I was offered
Amitriptyline a year or two back when in pain from my OA. I tried them for a
while without success and gave them up when I heard they were
anti-depressants. I have been taking Co-Proxamol for about 10 years now, but
have now managed to wean myself off them rather than try something new when
they stop prescribing them.
I guess I'm lucky in that I've been taking Diclofenac for about 10 -12 years
now with no side effects (that I know about), although I had previously
taken Arthrotec. They gave me the same effects you're getting with
Diclofenac.
Could you go back to your GP and get a different NSAID?
Splodge

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Coats - 19 Nov 2006 12:48 GMT

> Amitriptyline was originally recommended by my doctor as I was unable
> to get a decent nights sleep. Is that your problem Cathy?

Thats really only a secondary problem, the pain that is. I find I have pins
and needles in my arms and very stiff painful wrists on waking. Although I
do wake up when I turn over and try to lever myself round using my hands I
have developed a seal like strategy where I use elbows for any weight
bearing turning while in bed.

>I was
> offered Amitriptyline a year or two back when in pain from my OA. I
[quoted text clipped - 7 lines]
> getting with Diclofenac.
> Could you go back to your GP and get a different NSAID?

She has said I'm fine up to 1,000mg at a time although I'm a little wary of
this because of the damage it can cause to the stomach. Because I have no
absolute diagnosis everyone is very wary of giving me specific drugs and
prefer to blunder on til one actally works or my bloods give a definitive
answer. If they saw my joints on days like today I don't think there'd be a
problem with diagnosis but try as I might I can't get them to look this bad
on GP/Consultant visit days. :-((

I'll try them and see what happens, at least they might stop hurting while
they're being useless. :-)

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Splodge - 20 Nov 2006 07:27 GMT

> If they saw my joints on days like today I don't think there'd be a
> problem with diagnosis but try as I might I can't get them to look this
> bad on GP/Consultant visit days. :-((

I knew someone who had exactly the same problem as you, Coats. She solved
her problem by not taking her NSAIDs for a couple of days before her
GP/Consultants appointments.

It's a bit like making a claim for Disability Living Allowance. Do you
receive that? You have to fill in the form describing your very worst days,
otherwise you just don't get it.
Splodge

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Coats - 21 Nov 2006 07:43 GMT

>> If they saw my joints on days like today I don't think there'd be a
>> problem with diagnosis but try as I might I can't get them to look
>> this bad on GP/Consultant visit days. :-((
> I knew someone who had exactly the same problem as you, Coats. She
> solved her problem by not taking her NSAIDs for a couple of days
> before her GP/Consultants appointments.

I've tried, my joints seem to have a mind of their own. Cold is the worst
thing but unless I know I have nothing to do the day of the appointment I
really have to use my fingers for work. :-(

> It's a bit like making a claim for Disability Living Allowance. Do you
> receive that? You have to fill in the form describing your very worst
> days, otherwise you just don't get it.
> Splodge

I don't get DLA mainly cos I'm a social work student and I'm on the giving
end not the recieveing end. I'm nowhere near as bad as anyone I have on my
caseload at the moment. If pills can help me then I'm fine to carry on
helping others for a while.

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Piglet - 19 Nov 2006 01:41 GMT

> Went back to my GP after the rheumatologist said he wouldn't do
> anything...long story. After telling the new (to me) GP that I'm up to 800mg
[quoted text clipped - 9 lines]
> be one of the addictive sorts of anti-depressant.
> Anyone had this sort of treatment and if so did it work?

It is now a fairly common treatment for pain, especially of neuropathic
(nerve) origin, and where pain interferes with sleep. Side effects are
mild if the dose is started low (10mg is low) and increased slowly.
These include a dry mouth, sedation, nausea and constipation. To give
you an idea of how low the dose for pain is; when used for depression,
amitriptyline is normally *started* at 75mg a day and increased as
needed to 150-200mg. As a pain treatment is is rare to go higher than
50mg. It is NOT considered to be addictive, but may need to be withdrawn
slowly when no longer required.
Hope it helps!
Pete

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Robin Fairbairns - 19 Nov 2006 10:56 GMT

>Coats wrote:
>> Went back to my GP after the rheumatologist said he
[quoted text clipped - 21 lines]
>50mg. It is NOT considered to be addictive, but may need to be withdrawn
>slowly when no longer required.

i was given amitriptyline in the '60s, when i was a depressive
student. it didn't do a lot for me, and i found i couldn't take
alcohol while i was on it. i also had withdrawal problems when they
finally took me off it (as piglet remarked).

i know nothing about its use nowadays: just thought the alcohol issue
may be of interest. quite possibly, on a really small dose, the issue
doesn't arise...

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Coats - 19 Nov 2006 12:53 GMT

> i was given amitriptyline in the '60s, when i was a depressive
> student. it didn't do a lot for me, and i found i couldn't take
[quoted text clipped - 3 lines]
> may be of interest. quite possibly, on a really small dose, the issue
> doesn't arise...

I can't imagine you ever being depressive. ;-)

Was the alcohol problem that the pills didn't work or was it that the
alcohol was more potent? Just cos we do go out a couple of times a week and
I'd like to know what the risks may be of either not taking the pills or
taking them after a few pints.
Ta.

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Robin Fairbairns - 20 Nov 2006 13:01 GMT

>> i was given amitriptyline in the '60s, when i was a depressive
>> student. it didn't do a lot for me, and i found i couldn't take
[quoted text clipped - 5 lines]
>
>I can't imagine you ever being depressive. ;-)

remarkable what a good wife can do for a person. ;-)

>Was the alcohol problem that the pills didn't work or was it that the
>alcohol was more potent? Just cos we do go out a couple of times a week and
>I'd like to know what the risks may be of either not taking the pills or
>taking them after a few pints.

it made me feel extremely queasy -- to the extent of needing to go and
lie down. to first order, i didn't drink except when i was at home
(and i didn't take any other non-medical drugs either: i'm one of
those people who can remember the '60s...); so for me it wasn't much
of a social problem.

on a low dose, as i said, it could well not be an issue.

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Coats - 20 Nov 2006 21:44 GMT

>> I can't imagine you ever being depressive. ;-)
> remarkable what a good wife can do for a person. ;-)

You know thats what Allen says about me. And I say the same sort of thing
about him, well except the wife bit. ;-))

>> Was the alcohol problem that the pills didn't work or was it that the
>> alcohol was more potent? Just cos we do go out a couple of times a
[quoted text clipped - 6 lines]
> of a social problem.
> on a low dose, as i said, it could well not be an issue.

Right, thanks for that. I'll try them on a sliding scale. I like a glass of
wine with my tea so I'll have one tonight and see what happens. If thats ok
I'll have one on Wednesday after my 2 pints at the pub (quiz night).

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Coats - 19 Nov 2006 12:51 GMT

> It is now a fairly common treatment for pain, especially of
> neuropathic (nerve) origin, and where pain interferes with sleep.
[quoted text clipped - 7 lines]
> Hope it helps!
> Pete

Right, I think I could cope with dry mouth and being drowsy/asleep at
bedtime.I'll try the dosage for the 4 weeks the GP suggested and see what
happens.
Thanks

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sprocket@perverse.engineering.com - 26 Nov 2006 20:52 GMT

> Went back to my GP after the rheumatologist said he wouldn't do
>anything...long story. After telling the new (to me) GP that I'm up to 800mg
[quoted text clipped - 9 lines]
>be one of the addictive sorts of anti-depressant.
>Anyone had this sort of treatment and if so did it work?

This may be a bit late (I've been excessively busy for the past while)
but I've been on low doses (25mg) of Amitriptylene for about 8 years
now, and find it very effective in helping with pain (especially
during the night) and muscle spasms. As my GP explained it to me, it
can have a sort of assistive effect with painkillers, and the dose for
this purpose is much, much lower than that used as an anti-depressant.
As far as I remember from when I first researched it, it is not
particularly addictive, and on the odd occasion that I've run out, I
can't say I noticed anything other than an increased level of pain.

Anne

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Coats - 26 Nov 2006 22:57 GMT

> This may be a bit late (I've been excessively busy for the past while)
> but I've been on low doses (25mg) of Amitriptylene for about 8 years
[quoted text clipped - 7 lines]
>
> Anne

Thanks, I started taking them this week and although I haven't really
noticed much of a change yet I've only taken 5. I'll persevere and see if it
does help. I have 6 weeks worth so I will have an idea of what effect they
have on everything by then.

Thanks for the answers though, they all helped to give me a rounded view of
the treatment.

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