Antidepressants as analgesic

[benborp]

Does anyone here have experience of using antidepressants as an analgesic? Specifically for neuropathy.

I tend to use physical activity to keep a lid on various problems - but it can mean that I burn out if things get out of balance. I'm at a low point now and the prospect of several weeks with the current pain is a little daunting. However, I don't want to compromise my usual route to equilibrium too much.

Another issue is that my French GP is very keen to prescribe - basically inquiring about anything seems to be treated as a request for that specific treatment. Also their understanding of the underlying issue isn't great. So I'm reading up, but would also appreciate hearing from people that have similar experiences.

[hellymedic]

I am not a pain expert mostly fortunately lead a life of minimal and manageable pain.

I have heard amitriptyline can be good in small doses.

I think my Dad tried it and it left him very dopy but he is ancient.

It is known to be sedative.

[chrisbainbridge]

amitryptiline is the first line agent for neuropathic pain but in very different doses to the anti-depressant level.  So neuropathic pain would start at 5-10mg taken about an hour before bed time in order to relief pain and get the good nights sleep.

For more severe pain then any of the SSRI type medicines are often used.  Sertraline would be a very common prescription from our guys.

There are multiple reasons for this.  pain is depressing, it takes immense mental and "psychic" energy to cope with pain.  Also pain stops you sleeping and reduces the quality of your sleep so anything which helps trigger sleeping will be good.

Also your fundamental makeup affects how you process pain.  Given someones anxiety, depression and catastrophisation scores I can probably predict fairly accurately your medication needs after any surgery.  We are putting a lot of work into pre-emptive alteration of these scores prior to surgery in order to change your experience of surgery and the length of your journey.  Surgery becomes cheaper (less visits) but your experience becomes better.

[T42]

Good luck, Ben.  I haven't got that far yet but...

[chrisbainbridge]

On a more general point, your approach to treating the pain with natural endorphins, distraction and physical exercise is without doubt the best route.  Fundamentally there are no real painkillers.  We have ways of obtunding the pain with opiates, gabapentin, etc but they are all distractions from the pain rather than real pain killers in my opinion.

Self hypnotherapy can be very useful for some people

[MikeFromLFE]

I am not a pain expert mostly fortunately lead a life of minimal and manageable pain.

I have heard amitriptyline can be good in small doses.

I think my Dad tried it and it left him very dopy but he is ancient.

It is known to be sedative.

I was taking this stuff for a while, some years ago, for unexplained gut pain - it had minimal effect on the pain, but it certainly helped me sleep.
In hindsight the gut pain - along with quite a few other ailments around that time - was almost certainly due to stress.

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[Bolt]

Mrs Bolt was recently prescribed amitryptiline following acute sciatica resultant from a back injury at work.  A low dose taken before bed as Chris Bainbridge states did help.  Though she is still off work awaiting surgery, she is in far less pain and has become immersed in various crafting hobbies which, as Chris also advises, is working wonders as a form of distraction.

[T42]

On a more general point, your approach to treating the pain with natural endorphins, distraction and physical exercise is without doubt the best route.  Fundamentally there are no real painkillers.  We have ways of obtunding the pain with opiates, gabapentin, etc but they are all distractions from the pain rather than real pain killers in my opinion.

Self hypnotherapy can be very useful for some people

I remember reading years ago of a chap who had heart surgery when dosed to the gills with Valium, I think it was. Asked if he felt the pain he said sure, but he didn't care.

It's a strange phenomenon.

[benborp]

Thanks all. Lots of useful things for me to bear in mind.

The distraction aspect seems quite important, especially around sleep. Pain is something that I often deal with by detachedly observing it. At times it seems to be an overstatement to call what I'm dealing with painful, but the awareness of it can be overwhelming.

It seems that the sedative effects of some could be more helpful than I previously considered. Especially if their effects can be specifically used at bedtime.