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Anti-depressants for Chronic Pain

Posted Sep 07 2008 8:01pm 1 Comment


I have had several NL and pain docs recommend anti depressants for chronic pain. I tried them last year when a NL ordered 50mg of Amitriptaline(Elavil) for me to take at bedtime as my back pain gets much worse at night and I was having trouble sleeping because of the pain. Because Elavil makes a lot of people very sleepy (including me) it seemed like the perfect solution to have a drug which has a sedating factor plus pain relief.


Unfortunately when I tried it at 50mg I had major tachycardia. I don't know if I had this side effect because I already have issues with tachycardia but I had to stop taking it due to racing heart.


When I saw my cardiologist last month I mentioned this to him and he suggested trying it again at 10mg and then working up to 25mg. I have taken it for two weeks now (and it often does take several weeks to experience full benefits) I can believe how much it has helped, even at 10mg! I have much less back pain during the night and during the day as well. It also makes me sleepy and aids in a good night sleep.


I've included some info about it from the American Chronic Pain Assoc. Website below. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf This is from their medication supplement which I highly recommend reading. It has so much great info about all kinds of medication used in treating chronic pain. Their homepage also has some really great resources as well.


HOW ANTIDEPRESSANTS MAY HELP


While most people know that pain signals go up the spinal cord to reach the brain, they may not be aware that there are signals coming down the spinal cord that can increase or reduce pain transmission. By increasing levels of chemicals (norepinephrine and serotonin) at nerve endings, antidepressants appear to strengthen the system that inhibits pain transmission.


Some antidepressants may be useful in chronic pain because they effectively reduce anxiety and improve sleep without the risks of habit-forming medications. Some people with chronic pain are depressed, and treating the depression may also help reduce the perception of pain.


Many people with chronic pain find that antidepressants, along with learning other pain management skills, can help them regain control of their lives and keep their pain under control.


They help block the transmission of pain signals down the spinal cord. I always thought that pain signals travelled up from the spinal cord to the brain



The optimal role for antidepressants in chronic pain is still being defined as research progresses. These qualities seem clear, however.

�� They do not have the potential to cause stomach inflammation and bleeding, as do the anti-inflammatory drugs.

�� They do not seem to interfere with the body’s internal pain fighting mechanisms; in fact, they probably strengthen them by increasing the effects of chemical messengers, such as norepinephrine and serotonin, in the nervous system.

�� Many act as sedatives to promote a good night’s sleep. Sleep deprivation is often one of the major obstacles in coping with chronic pain. In fact, with severe sleep deprivation, one cannot cope with much of anything.

�� They may help to reduce depression.

�� They may help to relieve anxiety and panic attacks.

�� They may increase the effect of other pain relieving drugs or analgesics.

�� They are non-addictive pain medications, and loss of effect due to tolerance does not occur after the optimal dose for a given person has been determined.

�� They have a record of long-term safety and are among the most widely used drugs in medicine. There is evidence that in chronic pain, antidepressants may work at lower doses and blood levels than are required for depression, and they may produce responses sooner than the three to five weeks which is typical for depression. This is not always true, however, and some people require full doses for maximum pain relief.



They also have a great template for a pain log http://www.theacpa.org/documents/8%205x11%20Pain%20Log%202-8-06.pdf and I also love this little guy for helping illustrate what different kinds of nerve pain feel like http://www.theacpa.org/nerve/hurt.asp


I hope you find some of these links as helpful as I have. Since I have been taking Elavil I have been able to reduce the amount of pain meds I have to take during the day and that is great!
Comments (1)
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Hi Caroline,

     Not knowing the "why" of the pain it appears the symptoms have now become the diagnosis which is typical of a diagnosis that is truly sypmptomatic, not diagnostic.  

     Here are a couple of thoughts and ideas that may help you. 

     *  As is pointed out in the previous post there are what are called "afferent" and "efferent" pathways for pain.  Basically pain has been thought to be a directional path from the area where pain is experienced to the brain as the receptor site. 

       The stimulus originates distally and arrives proximally at the brain before we have the perception.  Some of the antidepressants may change the receptor sites and/or introduce endogenous ( from the body )  opioid peptides

( enkelphalins, endorphins) which could possibly affect the stimulus strength. 

       Enough talk and theory so let's move on to rarely using any drugs or possibly not at all. 

       If you have not tried interferential therapy ( 8,000+ pulses per second ) of a small pleasant electrical current into the area of pain then I would encourage you to do so.   If the therapy works you will know within 15 minutes of beginning the therapy. 

        Now the interesting aspect of interferential is it has for most people what is called " carryover pain relief" or often called "residual pain relief".  What this practically means is if your pain prohibits you from sleeping then you should begin a treatment at home about 30-40 minutes prior to bedtime, obtain relief, and hopefully the carryover pain relief will be sufficient for you to sleep most of night and break the pain cycle you are on. 

 

     The carryover effect is not understood completely as there is little research being done that looks at what chemical processes are going on as a result of varying polarities of the stimulus and how it is inhibiting the pain pulses.

 

      You will not have to deal with certain drug reactions like tachycardia, stomach irritation, anxiety reactions etc. 

 

      Here's a video that may help but no matter what try interferential before you continue on this antidepressant drug pathway. 

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