A few months ago, I wrote of my experiences with chronic pain and I mentioned I had started a regime of amtriptyline. Well, 6months and a referral to a pain clinic later and I feel I can report on how this is going and give a little bit of insight into how this drug, better known as an antidepressant, can help with chronic pain.
Amitryptyline was first introduced in the early 60s as a treatment for depression, and is now used to treat a range of disorders including insomnia, tinnitus, ADHD, migraine and… chronic pain. So how is it able to treat such a wide range of conditions? What does it do?
It is categorized as a tricyclic antidepressant and acts primarily as a serotonin-noradrenaline reuptake inhibitor, leading to an increase in the levels of these neurotransmitters. It also has effects on a whole range of receptors and ion channels including some which have been strongly implicated in pain such as TrKA, sodium/potassium channels, and nicotinic receptors, where is it thought to suppress activity in c-fibres, nerve fibres known to be involved in transmission of pain.
Of course, the doses used vary widely between conditions – from ~100mg in depression, to the 20mg dose I take for my pain. This low dose for pain means the side effects, which can be quite an issue in depression, are less severe. I’ve spoken to a few people who’ve tried it for pain before with mixed results – the most common issue has been drowsiness, which I agree with. I take it at night, initially before I went to bed, but have recently switched to a little earlier as I think it was making mornings even more difficult… given I already need 3-4 alarms to get my ass in gear normally! However, on the pain front, its effect is pretty minor for me. The drowsiness at night is actually the main benefit, as it smooths over the stabbing pains which made it difficult to get comfortable before… I’m struggling to notice any real effect during the day on the pain levels, but it has made a noticeable difference to my quality of life, which is the main thing really. If I’ve only learnt one thing in the past 5 years in pain research, it’s that complete removal of pain is a rarely achievable goal, and most patients (myself included) massively appreciate anything that makes the experience of chronic pain easier, be it problems sleeping, difficulty concentrating, or any of the myriad other ways pain can interfere with your day to day life
…so then I finally got myself an appointment at a pain clinic, saw a doctor who actually understood what I was feeling (woo!) and immediately prescribed me lidocaine patches… and it’s no exaggeration to say these wee guys are my favourite thing at the moment! Lidocaine is a local anaesthetic, and is often found in creams to help with sunburn and itching (not to mention its other, murkier, use as a cutting agent with cocaine due to its strong numbing effects). I currently have 5% patches, which I stick on my stomach every day to help with the post-operative abdominal pain, and they are brilliant! Completely removes the pain associated with light touch that has been adding a layer of frustration to my daily life for the last year or so (ID badge? Bouncing against you while walking? Shouldn’t be painful, no?), and it seems to also act on the shooting pains (which may, or may not be neuropathic). Unfortunately, I can only keep them on for 12hrs a day, and within 10minutes of removing them, the pain tends to return, but I’ve only been using them for 3weeks so you never know.
Lidocaine patches are actually only licensed for postherpetic neuralgia associated with shingles, but have increasingly been used ‘off-label’ for conditions such as endometriosis and other pelvic pain conditions such as those associated with adhesions, as I have. Worth speaking to your GP about, although mine was very reluctant (“too expensive“) and it was only once I saw a pain specialist that I was ‘allowed’ them, so there we go.
I was also given a TENS machine, which I’ve played with a bit, but I think I need to go back and get some advice on positioning of electrodes and the best settings to use as they’re not actually advised for use in the abdominal area for reasons I can well understand – some of my experiments with positioning have caused weird sensations all down my leg or in other areas which don’t quite feel right. If anyone reading this has experience with using TENS abdominally, I would really welcome some tips on settings and positioning!!
Anyway, that’s all from me for now – as always, feel free to ask any questions or leave any comments as I’d love to hear from you!