Pain management consultants have been recommending anti-depressant pills to cure intractable pain for quite a while now.
It was discovered 30 years ago that a side-effect of tricyclic antidepressants (TCAs) was to block the pain pathway to the brain. However, many GPs remain unaware of this or are reluctant to use them because of their association with mental ill-health.
Yet specialists who treat back pain say TCAs such as amitriptyline and nortriptyline are excellent when conventional pain-killing drugs fail to work. TCAs seem to increase the brain chemicals serotonin and noradrenaline, which in effect raises the pain threshold, so most pain is not felt.
To work as an anti-depressant, the drugs need to be taken in doses of as much as 150mg a day. For pain relief, they are prescribed normally at no more than 25mg. Experts say that at low doses and taken for up to six months, anti-depressants are non-addictive and side effects are rare, though some people may experience drowsiness or a dry mouth.
I have been on amitriptyline for a number of years now and have played around with different doses to get the best effect but anything over 30mg does cause a very dry mouth. It was so bad with me sometimes that I could not get my words out properly but it definitely helps you to sleep. I recently saw Roger Knaggs who was appointed Associate Professor in Clinical Pharmacy Practice at the University of Nottingham in September 2011 to provide a highly specialist pharmacy service to the Pain Management Service at NUH.
My pain consultant had made me an appointment to talk about the medication I am on. I found out more tips in that appointment than I have known for years. One of which I put into practice straight away. For years I have been taking my amitriptyline just before I go to bed and if I wake up at night and cannot go to sleep then I take another. This was, in fact, the wrong thing to do as the effect would then last well into the morning. He suggested I take it around 8.30pm and if I wake up in pain to take a Tramadol rather than the amitriptyline.
He decided that because I have been on the amitriptyline for so many years that maybe it was time to change it for nortriptyline.
According to a leaflet written by the Isle of Wight NHS – Amitriptyline and Nortriptyline are medicines used to treat depression and relieve chronic pain.
They are often helpful for nerve related pain, for high pain sensitivity (also called central sensitisation) and if the pain is leading to sleep disruption. Their effect is different from standard painkillers, so are often prescribed in combination. As they affect the central nervous system in complex ways, the effect often takes a while to be felt and requires regular intake. Amitriptyline and Nortriptyline won’t help your pain if taken as needed. We recommend a trial of at least four weeks to judge the pain relief effect. If good, it
may be taken on a regular long-term basis; if there is no distinct relief they should be discontinued after the trial period.
So, in a nutshell, they both work for pain it is just acase of finding which one suits you the best.