I am about to try and reduce from 5mg of Pd 4.i want to reduce as I am due to have root canal work at the dentist and want to minimise risk of infection. My GP has given me a prescription for 10mg of Amitriptyline twice a day, while I am reducing. Do you think it will help? Grateful for any comments.
Has anyone found Amitriptyline helps with PMR pain? - PMRGCAuk
Has anyone found Amitriptyline helps with PMR pain?
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Trulyscrumpious
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I don't think it will help PMR per se as PMR driven by inflammation and immune system. Amitryptiline is an anti-depressant that at low doses helps as a "weak" muscle relaxant and sleep aid. Its usually used in the evening because it can make you drowsy. I haven't heard of people being prescribed it twice a day. Although on my really bad days with fibromyalgia I did take my dose mid morning to help get the wrinkles out but I didn't drive etc on those days (was in bed!).
versusarthritis.org/about-a...
Trulyscrumpious• in reply to
Thanks for trying so quickly. I was rather dubious but i’ll have to give it a try.
I take amitriptyline for my depression and my gp upped it to try and get my sleep back on track but it definitely doesnt do anything for my pmr pain. It is a muscle relaxant of sorts so it may just have a slight effect on you but you will need to give it a go to see how it effects you.
Thanks Yellowbluebell. I knew it helped depression in large doses and I already take one tab at bedtime and it’s great for sleep. Will let you know if it does anything.
I will be interested to see how it works on you.x
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Very unlikely it will help with PMR pain - I wish I knew what make them think it will. PMR is NOT nerve pain. Nor is steroid withdrawal pain. Slow reduction, small steps and over a few weeks, is far more effective:
healthunlocked.com/pmrgcauk...
At 5mg the risks of infection with a good dentist is minimal - I had root canal work done as an emergency a few weeks ago at a pred dose of 15mg. No problems at all once the bruising round my jaw faded (that is what it felt like at least), keeping my mouth open for so long with PMR was the worst! I did have an anaerobic bacterial infection in the tooth - he didn't even give me antibiotics but this is Italy. I have had things done here by my dentist in the practice which in the UK they would admit you to hospital to do because of pred. The first time I was terrified - now I just say OK ...
Since the root canal stuff I have also had a pacemaker inserted, also at 15mg. Lots of bruising, all sorts of bits hurt but the incision is healing beautifully. Even managed to reduce by 1mg (not recommended really).
It's been quite a 6 weeks!!
Thanks so much PMRpro. You confirmed what I already felt. Really helpful.
And reassuring too about the dental risk. However I have been referred to a University dental school for graduates learning advanced techniques. They are very highly supervised but obviously not as skilled. It’ll save me a lot of money but do you think it adds an additional risk? My assessment was very thorough and they have the latest gear like 3D X-ray. I have to wait till Sept when the new intake arrives so they will be beginners. I’m wondering if I’ve done the right thing...?
When we lived in Birmingham we never went to the dentist , always went to Dental Hospital, great treatment and always had good results , all the dentists need to learn so the more complex problems they can see and learn from the better x
Never did any harm when I used the Dental Hospital - the worst dental attention I have ever had came from a dentist with probably 30 years of experience. If they are learning advanced techniques - they aren't beginners, just dentists learning how to do complex procedures properly under the supervision of experts. If you had it done at a practice you have no idea how many times they have done it before - maybe just the time they learned it at the Dental School!!
Thanks- your advice always seems to hit the spot!
It does doesn't it? We are very lucky. 👍🙂
Both my daughters needed sedation for quite a while just to have their teeth scaled because of the treatment they revieved from a supposedly very experienced dentist!. Its when she couldnt pull one of my teeth out she climbed on to the chair and tried from there that I changed dentists!! She has been struck off since!!
• in reply toYellowbluebell
Sounds like the wild west!!
Horrors !!
She was evil. Her husband was also a dentist and they were both struck off together so not sure what he did to upset people.
Blimey - thought my childhood dentist was a creep and the adult version awful. But that beats all!
She really was dangerous. I was actually sitting in the chair in floods of tears. Husband and kids outside wondering what the hell was going on! I made a formal complaint and at our new dentist met her old nurse who was more than happy to say both her and husband had been struck off! Think.there were quite a few complaints
How on earth did they last so long?
Have no idea but she was always busy! She was British bit je was Romanian and I heard they were back there!!
Didn't want to press 'like' for this one YB. Shocking! 🤫😳😡
Bloomin’ Aida! 😱
Yes I agree ,I went to the dental hospital in Liverpool England .They are all supervised and they are excellent .
• in reply toTrulyscrumpious
They don't allow them to do things beyond their skills. Of course they have to do things for the first time! They don't start a procedure until the tutor has okayed everything and checks at the beginning, middle and end. I have been going to the dental hospital for around 6 or 7 years. They have done very good work. I would probably trust them more than others. It is the keeping the mouth open for long periods that is an issue but it's fine once my jaw settles . My mouth would have to be open whichever dentist I went to!
Trulyscrumpious• in reply to
Thanks- very reassuring x
I’m having root canal work done too, over a bridge. I got an abscess and dentist said I might have to have bridge removed, and possible Implants😳. Part 1 seemed to be ok so far, but next week have to go and have a ‘rod’ inserted. Hope it works. I too found keeping my mouth open the worst, and swallowing. I have a constant cough too which doesn’t help, nor the backache in the chair. It was an hour long session, and the next one half an hour. I have never taken Alendronic acid, and it was necessary to have the work done (at great cost ☹️). On the plus side am not scared of going to the dentist!
Sounds as if you are pretty stoical. Good luck with part 2. Let us know how it goes. I thought everyone who was on Prednisolone had to take Alendronic acid....?
After looking on the forum about AA and reading about all the side effects I decided to not take it. It's a personal choice.
I have osteoporosis too, also swallowing problems and refused AA. As for being stoical, for some reason am ok with the dentist- haven’t always been this way. Have to transfer my thoughts! Nervous of hospital visits though, - put off cataract surgery, when I was given the choice. I shouldn’t be given choices!
Will report on part 2. Dentist said last time that he wouldn’t want to do more than one a day.
An hour and a half in total sounds bliss! The second appointment I had was 3 hours - and the x-rays in the middle alone took half an hour as we couldn't get the wand into the right position was it was right up in the upper back corner. At least the gag reflex made me laugh rather than anything else!
Even AA comes under free choice! My bone density, originally hardly into the osteopenia range, barely changed over more than 7 years on pred plus calcium and vit D - suppose it is time for another really. AA should not be used without good reason - and that means not for a "normal" bone density.
Interesting. Am about to have another bone density check . If it is normal does that mean I could stop AA?
Depends on the t-score - but mine were -1.3 or better. -1.0 is normal, -2.5 is defined as the borderline to osteoporosis. In over 7 years mine has got to -1.5 and better - no AA, just calcium and vitD.
Thanks, i’ll Wait and see what mine are. What are the harmful effects of taking AA?
It can cause gastric discomfort. It remains in your body forever (probably) and many dentists are very reluctant to do invasive work on patients taking it or who have taken it. It can cause jaw necrosis - so can pred though it is very rare but both together may increase the risk. But IMHO, whatever it is, if you don't really need them, why take extra drugs?
Amitryptylline can drop your BP, so be careful in the adrenal zone when your BP can be little dodgy anyway.
I was prescribed it as an adjuvant to analgesia with slipped discs. Didn’t help, and kept nearly passing out due to postural hypotension. Also gave me nightmares.
Strangely if I forget to take my amitriptyline (150mg) at night I have very weird vivid dreams.
Dare I suggest when you don’t take amitryptylline you get a more ‘normal’ pattern of sleep? Amitryptylline may knock out the REM sleep? No idea really.
A book worth reading: Why we sleep by Matthew Walker.
I ran out of amitriptyline a few weeks back and had two days without. Can honestly say they were the most horrendous nights ever. I fell asleep a couple of times but ended up with about 2 hours sleep in total but it was just weird. When I have had sleepless nights but with amitriptyline I reckon they were easier to cope with for some reason. No logic to it at all!!
No. Sleep is a very complex thing. Have just been reading about magnesium’s impact on sleep (and depression, and thyroid, and.......)
That's why I tried magnesium spray. There was a very small improvement for about 3 days then it reverted back to 2/4 hours again. When you end up back where you were its hard not to just give in and accept you will never have a full nights sleep again!!
Frankly I'd have thought you'd do better with one of our tried and true home remedies like a cup of ginger tea to relax and provide a mild anti-inflammatory effect. But that's just me.
Real ginger tea - a teaspoon of freshly grated ginger root steeped for at least 15 minutes.
I tend to agree. My last port of call would be ‘sleeping tablets’.
Can you reduce by half mg Truly? A 1mg drop from 5mg is 20%. It’s a big ask.
What about alternating days- 4mg one day and 5 mg the next? I don’t have a pill cutter.
That’s probably a better plan than a straight drop. Or check out DL’s simple taper.
I’ll see if I can find the link.
Have you tried Paracetamol as it does have some anti-inflammatory effects-it is often used in premedications in conjunction with other drugs to prevent infusion related reactions so worth a try.When I get PMR pain instead of upping my Pred dose I try it and it really helps
Thanks. Paracetamol has never helped me in the past- like taking sweeties. But recently discovered Paracetamol with Caffeine, which is much better- perhaps the caffeine helps absorption? I’ll try it if needed.
Amitriptyline doesn't help PMR pain .
It is often used as a muscle and nerve relaxant for other non PMR related pain but is usually taken at night because it can make you drowsy.
It's sometimes given prior to minor surgery for a few weeks to some people with neuropathy related pain issues to help reduce sensitivity and pain , but again usually at night .
It is more often prescribed to people with GCA/ PMR to combat insomnia related to higher doses of Pred , or nerve pain as tapering to a lower dose sometimes identifies other types of neuropathy causing pain in the muscles.
It can help for that , but some people get palpitations from its use and find that it can increase insomnia instead , this can happen more often if you suffer from other joint issues or fibromyalgia .
It may help by the time you get to surgery , but I personally would only take a night dose as is more usually prescribed at the 10mg not both doses.
Thanks, it’s what I suspected so if necessary will take it up with my GP or just tell her it doesn’t work!
I already had an abscess on my gum where I previously had route canal work, and a bridge just below that.The bridge might have aggravated it, along with my electric toothbrush! Am a bit heavy handed with it. I wasn’t given antibiotics or anything, but despite this, part one seems to have gone ok so far. Part two next week.
It sounds as if you are in safe hands at the dental school, especially as they are graduates, enthusiastic and not jaded!
Did you know there is (or was) an electric toothbrush that rings if you exert too much pressure?
No, I didn’t! I used to have one which lit up. I’ve have two speeds and I forget to use the slower one. Think I’m too aggressive with them, rather than letting the brush do the work.
• in reply toClarkB
It's almost like the lighter the touch and stiller the hand the better electric toothbrush brushes work. I do 1 tooth at a time and let the brush do the work.
ClarkB• in reply to
I just forget and tend to use it like a normal toothbrush- despite having ‘lessons’ from the hygienist. Over aggressive cleaning will surely create more problems. Think my solution too, is to clean them earlier in the evening, rather than when I’m overtired and faced with flossing and special attention to bridges. It is important but sometimes I think along with everything else, small tasks seem almost too much!
• in reply toClarkB
I get that clarkb. I brush my teeth twice a day a few hours apart but not necessarily first thing or last thing. It is a long job if at night and I wouldn't do it properly. I have superfloss and 4 sizes of interdental brushes. My charge ran out in the brush one day and honest I couldn't remember how to brush my teeth. Obviously partially brain fog, but my hand wouldn't brush. 😁😂😂😂
That was why I got an electric brush - I couldn't brush properly because of the PMR effect on my arm!
GCA not PMR but doctor gave me Amitriptyline for muscle pain at night from the Pred. 10mg knocked me out for 24 hours. I felt awful. Groggy and out of it. Couldn't drive or concentrate. But I do know some people can tolerate it
I tolerate it very well. I was on 40mg for a short period after hip surgery. No grogginess! My friend can’t get up in the morning after just 2.5 mg. I rarely get side effects from any medication but they sometimes just don’t work- like paracetamol. I was on oral morphine for post hip op pain and it didn’t touch the pain. We’re all different.
Hi,
i seem to get a lot off side effects to a variety of drugs but paracetamol taken regularly works really well for me, so yes our bodies are so different, I wish doctors acknowledged that more often.
I have taken Amitriptyline in the past but not for PMR and it was only 10mg. I took it during
the day, it knocked me out and it affected me quite badly. Continuous dry mouth and I felt I wasn't on this planet. Tried them at night, slept very well, didn't even move, but in the morning I felt really groggy, wasn't sure where I was and the dry mouth continued through the day. It took me about an hour in the morning to get myself together. That's my experience and I'm sure it doesn't happen to everyone. The sooner I got off the Amitriptyline the better. I'm sure there are more qualified people than me who no doubt will advise on this but I can't see how Amitriptyline will help with PMR or be a substitute for PMR symptoms. I hope everything works out for you.
Thanks. Sorry you had such a bad experience. Just shows how different we all are. I agree that Amitriptyline is very unlikely to do anything for PMRpain.
I hope it all works out well for you!
Didn’t do a thing for me. Only answer was prednisone!
Amitriptyline is used for depression. I would ask the Dr why this is being recommended to you. Look it and possible side effects up and check the source of what you find.
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