‘Little evidence’ whether or not most antidepressants work for chronic pain

[helvella]

Last year, I took a fairly low dose of Amitriptyline for the effects of shingles - primarily pain.

I think it helped a bit - and it definitely seemed to help me sleep. But the side effects were unpleasant. (Tiredness, especially in the morning. Dry mouth.) Though in such situations, it is always going to be difficult to tease apart what is caused by the disease and what by the medicine. Still, I was very pleased to get off it.

I am not surprised by this article. Nor have I been surprised at the many members who have been offered various anti-depressants for the symptoms of thyroid issues (including under-dosing and failure to diagnose at all).

Sometimes which medicines we prescribe seem to have a lot in common with colours and hemlines. Fashions come. Fashions go. And people seem unable to resist them. - In this case, doctors seem to have convinced themselves that anti-depressants work - rather than there being ample scientific work to show this. But it has reached the point that patients who reject anti-depressants have few, if any, other options. Diazepam, Tramadol, etc. having been demonised, so they are mostly beyond our reach, and gabapentin and pregabalin having their own problems, there is little else.

For myself, I am so very much happier using topical capsaicin cream. It's under my control. It works. And it really doesn't seem to cause any significant issues except when I get some in an eye! But I am so very lucky to have that option.

‘Little evidence’ whether or not most antidepressants work for chronic pain

Researchers say ‘studies not good enough’ to know whether medications work or not for pain

Antidepressants commonly used to treat chronic pain lack evidence as to whether or not they work, researchers have said, declaring the situation a global public health concern.

Chronic pain, typically defined as pain lasting three months or more, is a widespread problem affecting up to one in three people, with conditions ranging from osteoarthritis to fibromyalgia.

Rest of article can be accessed here:

theguardian.com/society/202...

[arTistapple]

Well that is ‘good’ news in that it is what many patients have observed, re: the anti-depressants. Love the hemline observation. I most certainly agree AND I agree with the support of complementary treatments where possible. We need as clear a field as possible at all times re: our thyroids. Taking a whole bunch of unnecessary orthodox meds really messes up our view, when something causing less ‘trouble’ could be more useful. Doctors however, mostly, are unaware of these (and/or downright against them). This is good info about the capsaicin cream. It can also be used homeopathic ally/internally and gives good results. Can work for reflux too. When we are dealing with something which can’t as yet be ‘cured’I much rather like to use other ways of dealing with ‘symptoms’ when possible. Unfortunately this info is not always widely available and dosing (just like with hypo meds) is is often not known about or understood. Much better than reaching for the Formulary for every symptom until we have lost sight of everything we are trying to do!

[helvella Administrator in reply to arTistapple]

It is great about the capsaicin.

But I find it odd that they have made it prescription-only.

However, that doesn't matter much as it has been unavailable for over a year in the UK!

I currently buy my own from Germany where it seems to be over-the-counter - equivalent specification and works just the same. Primarily a matter of cost and significant inconvenience.

[wellness1 in reply to helvella]

Thanks for posting this. It's really hit or miss with pain medication. Everyone has to trial things to see whether they benefit and how they fare with side effects.

I'm glad you've found something that helps. Is there a reliable source for capsaicin cream you would recommend?

[helvella Administrator in reply to wellness1]

Yes - I use:

versandapo.de/

But others could work out cheaper. I preferred to avoid other sources - such as eBay because when I looked, I was unsure about the products offered. Have not revisited.

ABC Warme Cream 0.075% - is what I use. Very similar to the unavailable Cephalon Axsain.

[wellness1 in reply to helvella]

Danke

[LynLyn in reply to arTistapple]

I’ve read your reply with great interest. How does capsaicin cream work for acid reflux? Many thanks

[helvella Administrator in reply to LynLyn]

I'm glad you asked that!

I've been scratching my head (not literally!) and wondering.

[arTistapple in reply to LynLyn]

Not in cream form. It’s given in little pills to melt under the tongue or another way is dissolved in water (this is usually made up and prescribed by a homeopath). However you can buy the pills direct from a pharmacy like ‘Helios’. If you decide to try it get what is considered a low dose say 6c. You have to use them for a while.

[LynLyn in reply to arTistapple]

Many thanks for you reply!

[helvella Administrator in reply to arTistapple]

Just to be 100% clear - in case anyone is at all confused - the capsaicin cream I use is not in any sense homoeopathic. It is seriously hot with a measurable (and feelable) amount of capsaicin.

[arTistapple in reply to LynLyn]

P.S. Don’t take as many as it says on the box or you can overdo it. Better to under dose than over dose.

[GlowCoach Administrator]

Amitriptyline dose seem to work for some people. Its now on my list of meds I've had adverse reactions to though.

Doctors just want a cheap fix. They tried prescribing this to me for a number of different things and its only ever made me worse. 😐

Good thats its being highlighted they have no evidence for prescribing it for pain. Fancy that!

[jimh111]

It never ceases to amaze me that when the doctor's brain can't figure something out they treat the patient's brain!

There are cases where antidepressants have a pain killing role and it would be shame if this is lost. For example, low dose amitriptyline for IBS. The dose used is too low to have a psychological effect but it acts as an NMDA receptor antagonist. NMDA receptors transmit gut signals and pain, hence amitriptyline can be useful.

Some drugs have more than one role so we should beware generalisations.

[helvella Administrator in reply to jimh111]

I don't want any effective (and sufficiently safe) medicine to be banned.

But I was refused anything but amitriptyline, then duloxetine.

NHS says about amitriptyline:

You may start to feel better after 1 or 2 weeks, but it can take 6 weeks for amitriptyline to work as a painkiller.

Amitriptyline can cause extra side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.

That means, not suited to modest term issues. And you are committed to it if you want not to stop suddenly. Far from ideal for something that is only expected to last a couple of months. And it delays even looking at anything else.

They struggled even to provide anything topical - eventually I did get some Vagisil (!!!). But so far on I'd already sorted something else out.

[jimh111 in reply to helvella]

I think amitriptyline has a role in shingles but I don't know anything about it. This sort of therapy needs expert care which I suspect you didn't get.

[arTistapple]

Well Hell Helvella! I can see you are suitably impressed. Made me laugh!

[humanbean]

I've mentioned this before, but I was offered Amitriptyline for chronic pain, and at 20mg per day it did help. Unfortunately it also gave me tachycardia with a heart rate up to 150 beats per minute and I had to stop taking it. I was also offered Nortriptyline (biochemically the same family of drugs as the Amitriptyline), and that gave me tachycardia too - up to 135 beats per minute.

Tachycardia is a known side effect mentioned in the Patient Information Leaflet of both these drugs.

.

I have a history of low iron all my life. In my 50s, I started to test and treat my own low iron.

I discovered that, when my iron results were much improved, it eliminated my anxiety and massively reduced my depression.

In my youth doctors sedated females and treated males. I was put on valium rather than treat my chronic health problems when I was in my teens.

That is still the main method many doctors use for treating women - sedate them to make them shut up and go away. Anti-depressants, not real treatment.

[JGBH in reply to humanbean]

I agree with your views of how doctors still treat women even though many GPs are women nowadays… they have obviously been brainwashed by perhaps (?) male mentors… plus ça change and all that…