Amitriptyline, how long it takes to work?

[marinamarinka]

Amitriptyline for pelvic pain. How long it takes to work? The very first day I took it , got rid of my pain, 90% , but day two, and no pain relief whatsoever. I had a lap done and still in pain, Dr. said its purely neuropathic and prescribed it. Worried now

[Alaine1 Administrator]

Hi,

Amitriptyline takes at least 3 weeks to start to work so for you it’s very early days. I take mine with pregabalin. I initially took it with gabapentin which didn’t work very well so it was changed after a year to pregabalin. You might later on need to have one of these added in or the dose of amitriptyline increased. I’m on 20 mg but can’t go any higher as I can’t get up for work the next day or function at all. It leaves me feeling too ‘hung over’. You might feel like this initially on it but that does get better as your body adapts to the medication so please don’t worry especially if you are on a low dose. So people end up on a high dose as that is what works for their pain and they are able to tolerate it. The thing with any form of pain management including neuropathic pain is that they aim to reduce your pain by 50%, any more than this is a bonus. This is something that pain specialists don’t explain very well or at all when you see them. The fact that your pain reduced on day one is likely to be unrelated to the medication and just a chance event so at this stage I’m not concerned and I don’t think you need to be at this stage. Please let us know how you get on.

[marinamarinka in reply to Alaine1]

Thank you! I am on 25 mg and it made me tired only on the first day, felt groggy next morning, but now quite fine on day two. I had a lap where they cut out small endometriosis but from the opposite side where my pain is. I was suffering right sided pain for over two years since 2016. They now looked into every possible scenario, endo, infection, PID etc. And came to conclusion its neuropathic and it got worse after my lap too. It did make me calmer, much needed thing after every time I had pain it was setting me off. Yes I did red about Lyrica a lot too and I might need it in future, see how I go in 2-3 weeks on amit.

[charlee4 in reply to Alaine1]

I started a comment and suddenly it all disappeared. I asked my doc a while ago to consider starting me on Lyrica. He said I would have to come completely off Gabepentin first. I have been on high doses for several years. I am on 1800 mg. daily divided into 4 hour intervals. I was taking 2400 per day but I have been trying for a little more than a week to reduce it on my own. That is the only way the doc said I would know how much it is helping.

Did you come completely off Gabepentin before going on Lyrica? How much Gabepentin were you taking, about how long, and how much Lyrica are you taking?

I need some comfort, I hurt all of my day time hours and until I am knocked out at night. I am going to try and put some into into my profile for reference.

[Alaine1 Administrator in reply to charlee4]

Lyrica is stronger than gabapentin which is why it’s usually used as a second line treatment after trying the maximum dose of gabapentin first. I’ve was on gabapentin for almost 3 years before switching to lyrica which I’ve been on for 3 years. I’m currently taking 300 mg and 20 mg of amitriptyline which is the maximum I can tolerate. For me neither of these treatments have been hugely beneficial but I do have pelvic pain from 3 different pelvic pain conditions so this might be one of the reasons. It is a case of trying it and seeing what works as everyone is different including the severity of medical conditions, response to treatment etc. At the moment there doesn’t seem to be a wealth of data which can be used reliably to predict who will respond and for which conditions or if a condition for that individual will be more neuropathic type pain or if it is more inflammatory. For me all of mine have shown more of an inflammatory response but I am hoping to start reducing dosage in the near future to see if I genuinely need these 2 medications and at what dose. It’s a very tricky question to answer but it highlights some of the difficulties in treating pain - who has inflammatory type pain and who shows a more neuropathic type and at what doses are needed - it’s likely to be different for different people even with the same medical condition(s)