Medication

[Keli80]

I have recently been diagnosed as having chronic pain syndrome radiating from my lower back. I have had 4 years of being passed from department to department. Scans, mri's, physio etc. I am actually relieved that I now have a diagnosis even though it was not the outcome I hoped for. I have been on regular naproxen for over a year now. My pain nurse has recommended amytrptillin( no idea if that is how you spell it) at night as I am regularly woken by the pain. Does anyone have any experience of this drug and what can I expect in terms of side effects? Thanks

[earthwitch]

For chronic pain, you take amitryptylline at a much lower dose than is used for depression, typically 10 to 25 mg at night (it is 50 mg or more for depression). You usually start at 10 mg and then just increase slowly if you need to (some people don't) to get results. it will definitely make you feel quite hungover in the morning the first week or so until you get used to it, then that feeling disappears and you should get on fine with it. To avoid the worst of the hangover feeling, take it a full 12 hours before you want to wake up in the morning and that way you sleep off the worst of it. Also, you might want to start taking it when you have the next couple of days that you can take it easy and not have to be on peak form, for example, perhaps taking the first one on a Friday night to give you the weekend to get used to it. Even though it is an antidepressant, at low doses it has been proven by proper medical research to have a good effect on most people in modifying pain. Definitely worth a try.

[Keli80 in reply to earthwitch]

Thank you. I am just waiting on getting my prescription so will follow your recommendation and maybe wait till next weekend to give it a try

[Shakou]

I can't take it doesn't work for me... Even small amounts I feel messed up all the time, so won't touch it ever again. That doesn't mean it won't suit you, it is trail & error find the medication that works for each person.

What is wrong with your back, something must be causing the pain...

[Keli80 in reply to Shakou]

It was an injury initially but this has long since healed. Mri and X-ray show nothing wrong but constant pain. It has been described as a continous loop where my body will not register the pain should be gone.

[Shakou in reply to Keli80]

Sounds similar to me.

I have a hyper sensitive CNS, the initial injury has healed (apart from the prolapsed disk) which was probably caused by the above. I have found physical therapy, electro acupuncture, are working well at the moment, I'm going on a resident pain management course. All of those will help. Stress, worry, lack of sleep, diet, anything that affects CNS activity will ramp up the pain you are in. Also I used to drink too much, you can't really touch booze & drugs unless your meant to take them, they will mess you up big time hence why I have stop. Change of lifestyle for me, no more wild parties that last all weekend! Will be a change to more sport, being active once my back has healed.

Ask about taking duloxetine, I have found that is the only medication that works for me, I'm going to ask for medical cannabiss as that has shown to help with central pain. It will take time, I have been told another year to see around a 75% recovery, but I will always have it. I'm going to have to change how I live otherwise it will control me, rather than me controlling it.

Goodluck! There is hope you just have to be brave & dig deep once you do you will get better as I am. There will be good days & bad days.

[earthwitch in reply to Shakou]

I personally wouldn't recommend Duloxetine to start with - for the simple reason that it is incredibly difficult to get off it again (even after a few months) if you need to stop it. Duloxetine is a quite different type of drug that has a much more intensive impact on your brain (severely messes with serotonin levels), that can mean that withdrawal effects when you try and come off are almost worse than the problem you were taking it for. Also, that class of antidepressants haven't actually been proven with medical research to have any real benefits on chronic pain (whereas amitryptylline has). Amitryptylline is a much easier medication to come off (though you should still come off slowly), so as well as it being a more proven medication, I would say that it should be the first thing tried. Save duloxetine as a last resort. Duloxetine (and other meds of this group) can also trigger some really odd psychological stuff, including negative impulsive thoughts, which can be very scary. I realise it can be a wonder drug for some people whose depression hasn't responded to anything else, but I do wonder if GPs and other docs handing it out like sweeties for pain really understand the potential negative effects of it.

[RAYJAYC in reply to earthwitch]

I'm not wishing to argue with you but Duloxetine has been proven to help with nerve pain; no I don't have the written evidence to post on here! 😊

I've been seen by four different hospital pain teams and they all 'wanted' me to take Duloxetine for chronic pain & nerve pain. (I actually take it for depression but its positive side effect of nerve pain properties has stopped anyone taking me off it when 'dealing' with and wanting to review my depression; the pain teams politely asked my Psychiatrist to keep me on it!!)

I agree with your sentiment that it shouldn't be given as a first line medication as it's quite potent so others should be tried first but if four different hospital specialists want to use it for chronic and/or nerve pain then there must be some confirmed evidence out there??

(I've only been to four different hospitals because of extra chronic pain treatments; I haven't sought four different opinions 😊)

RJC x

[Hidden in reply to Keli80]

Have they mentioned taking gabapentin? It helps me a little! Am also on zomorph- although I have slowly reduced the amount I was prescribed. I don't like the brain mist it gave me- nothing really stops my continuous pain- it's all a viscous circle for me. I find it very difficult to pace myself!!!

[stokebones]

Dry mouth, sleepiness, tiredness and constipation are the most common side effects.

Dose is usually started low at about 10-25mg at night and increased up to about 75mg unless you see a consultant who go above (albeit unlikely to be more helpful).

Has no-one else suggested any other medication ?

[Keli80 in reply to stokebones]

No other suggestions so far. They have prescribed a low dose initially. 10 mg to see how I get on.

[stokebones in reply to Keli80]

Sorry to hear you have suffered for 4 years, and no-one has even offered you medication to at least take the edge off until they find the cause / can treat.

[terri19]

I couldn't get on with this drug either, like the last reply, it's all trial and error . Good luck 😜

[Debbs73]

Hi. I take 75mcg amatriptaline on a night to try and help me sleep sometimes it works and I may manage to get a full night sleep but more often than not my sleep is distributed due to the severity of my pain.

[sigrid]

look it up in google

[Kerry682]

Yes I tried amatripyline didn't like it made me feel

So stiff in the morning I have a bad neck and I literally couldn't move it so I didn't take anymore but slot of people use it with good results x

[Oma3]

I did not have any relief at all. My side effect was weight gain that I could not tolerate. I stopped it per GP.

[carol-1966]

Hiya im on amiytriptaline 50mg at night when i do finally drop off to sleep im away with the fairies but although im awake the next morning i find it really difficult to open my eyes im then very slugish for the first hour of my day i take this for l5 s1 pain im waiting to go in hospital for a spinal fusion amiytriptaline works for me unless my pain is really bad hope it works for you good luck xx