Tricyclic Antidepressants in the treatment of Neuropathic Pain

Patient’s are often confused when Doctors prescribe antidepressants to relieve their pain. I have had conversations with patients who are concerned they have been “fobbed off”, or feel their GP is implying their pain is not “real”.

Pain coming from damaged nerves is referred to as Neuropathic pain. This type of pain is usually described as “shooting”, “burning” or “stabbing” pain. The most common types of neuropathic pain are diabetic neuropathy, postherpetic neuralgia, trigeminal neuralgia or post-stroke pain. The pain generated by these conditions is different from the pain signals received from damaged tissue (e.g. a fall, a cut or an arthritic joint). For this reason, people with Neuropathic pain will not generally get much relief from using painkillers such as paracetamol or ibuprofen. However, some medicines used to treat depression or epilepsy can be really effective in treating this condition.

The most common medication prescribed to treat neuropathic pain – Amitriptyline – belongs to a group of drugs called tricyclic antidepressants which can also be used to treat headaches and depression. The dose of Amitriptyline used to treat Neuropathic pain is usually much lower than when prescribed for depression.

How does amitriptyline work?

Amitriptyline works by increasing the amount of specific nerve transmitters in the nervous system, reducing pain messages arriving in the brain.

How long will it take to work?

Every patient is different. You may notice some initial benefit within 2 weeks, however it may take up to 2 months for a full effect. Your doctor may need to increase the dose to get the maximum effect. Amitriptyline does not work for everyone. If you do not feel any improvement in your pain, do not suddenly stop taking the tablets but speak to your doctor.

What are the possible side effects?

Most side effects are mild and it is expected that they tend to go away after a few doses. Common side effects include; drowsiness, dizziness, dry mouth, constipation and sweating. If you have these side effects and they are severe contact your doctor or pharmacist for advice. Less common side effects include fainting, trembling, irregular heartbeat, blurred vision or problems passing water. If any of these side effects occur contact your doctor or pharmacist for advice.

There are other drugs that can also be used to treat Neuropathic pain, as well as other conditions. These include:

• Duloxetine – also used for the treatment of bladder problems and depression
• Pregabalin & Gabapentin – also used to treat epilepsy, headaches and anxiety

For more patient information on Amitriptyline visit the British Pain Society website.

References:

British Pain Society: https://www.britishpainsociety.org/static/uploads/resources/files/FPM_Amitriptyline.pdf

Cochrane: http://www.cochrane.org/CD008242/SYMPT_amitriptyline-neuropathic-pain-adults

NHS Choices: https://www.nhs.uk/conditions/peripheral-neuropathy/treatment/#relieving-nerve-pain

CKS: https://cks.nice.org.uk/neuropathic-pain-drug-treatment

For more information on the osteopathic treatment of someone with Neuropathic pain please contact me on lorna.osteopath@gmail.com or 07534933516