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Misc Amitripyline for pain Questions

barnstable84

barnstable84

Bluelighter
Joined
Nov 4, 2008
Messages
207
Location
victoria, australia
Hi Guys, long time no post!

I've just been prescribed Endep (Amitripyline) for pain. The backstory is that I was in a car accident when I was young and almost had my leg ripped off. Long story short, I ended up on Tramodol 100mg SR, 1 tab twice a day.

It was working really well for me until I started finding it was "gearing" me up and making me feel all speedy. This lead to me being unable to get good sleep and was then prescribed Stilnox (zolipidem) to counteract that. It works brilliantly for me. I used to mildly abuse the zolipidem but have moved past that now.

Anyway, the doc suggested that Amitripyline could help stop pain signals and may also work on the sleeplessness issues altogether. He gave me the 10mg tabs and said to just stop if the side affects are worse than the benefits.

I've done a bit of research here and see the following:

TCAs/Tricyclics
Mechanism of Action
TCAs work by blocking the reuptake pumps of various NTs; most TCAs affect primarily the reuptake of serotonin and norepinephrine. By reducing the reuptake of these NTs, TCAs increase the levels of NTs in the synapse. Thus, TCAs are thought to increase the levels of 5-HT/NE/DA in the brain. The main difference in action between TCAs and SSRIs is that that only SSRIs selectively act on serotonin reuptake.
It is possible to become dependent on TCAs – thus is you stop taking TCAs suddenly, you will suffer withdrawal symptoms.
Common Side Effects
Sedation/fatigue, tremor, insomnia, blurred vision, constipation, urinary hesitancy, confusion, orthostatic hypotension, conduction defects, arrhythmias, aggravation of psychosis, seizures, weight gain, sexual dysfunction (inability to orgasm and decreased libido).
Metabolism
TCAs are rapidly absorbed and metabolized. CYP2C19 is the most important enzyme involved in the metabolism of TCAs, but the enzymes CYP 1A2, 3A4, 2C9 and CYP 2D6 are also involved.
Recreational Drug Interactions
Alcohol, Benzos (Xanax, Valium, Klonopin etc), Opiates (Heroin, Codeine, Vicoden, Oxy etc), Barbituates, Ketamine: Because TCAs have strong sedative effects, combining TCAs with central nervous system (CNS) depressants like the drugs listed above can potentiate (make stronger) the effects of those drugs. I.e., if you are taking a TCA, you will be MORE SENSITIVE to these drugs, and you won’t need to take as much to get fucked up. Therefore, please dose carefully; you will probably need a lower dose than a normal person. Otherwise, these drugs are fairly safe to combine with a TCA.
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Are there any BL'ers out there who have become dependant on this drug or an experience on anything I might need to know that's not explained in the AntiDepressant Mega Thread? My Doc did say that it may not help the pain side much as most of my pain may not be nerve pain, but that it might be good for the sedative affect.

I also want to know if there is anyone out there who has had both tramadol, promethazine and the zolipidem and Amitripyline together with adverse side effects that were different to the explanation above? I'm not taking all at the same time, but they are all something I do use often and just want to cover my bases. I really don't want to fuck myself up on it if it's not going to really help with my pain issues.

I'm not game to try it until I find out!

Anyway, feel free to kick me out if i'm asking silly questions and I appreciate any feedback i'm given :)
 
The withdrawal from tricyclic antidepressants is hardly anything at all, the tramadol you are taking produces far worse dependence/withdrawal. I took roughly 3x the dose you were prescribed but in the form of nortriptyline, a newer tricyclic.

Did your doctor warn you about the seizure risk? Tramadol + amitryptline lower the seizure thresshold so make sure you pay attention and be VERY careful when adding any other medications. Its not a very high risk of seizure (especially since you are far from maxing out the doses on either drug), but be careful.

Promethazine and amitriptyline are both anticholinergics so will have similar side effects... dry mouth, sedation, etc. Taking both may increase the side effects, unless until you build up a tolerance to them.

I have taken nortriptyline, tramadol and zolpidem together without incidence but I always really hated ambien regardless.

If you have any other questions about pain-related issues, go to the OD directory at the top of the page and check out the chronic pain mega thread, LOTS of useful info in there.

Take care
 
^When it comes to nerve pain, TCA's are typically the first line treatment and have some of the lowest NNT numbers for nerve pain. NNT is the number needed to treat meaning how many patients must be given the drug for 1 to receive 50% pain relief.

TCA's NNT is about 2.5 which is on par with morphine and oxycodone but has a higher NNH or number needed to harm. NNH is the number of patients given the drug for 1 to drop out due to side effects, so the higher the better and IIRC, the NNH of TCA's is about 14. I made a chart of all the commonly used drugs for chronic pain in the CP megathread comparing the NNT and NNH so check that out for more info and to see how all pain treatments stack up.

Essentially due to the combined NNT and NNH of TCA's, they are the most effective nerve pain agent with the fewest side effects.

Chronic Pain

The TCAs show efficacy in the clinical treatment of a number of different types of chronic pain, notably neuralgia or neuropathic pain and fibromyalgia.[10][11] The precise mechanism of action in explanation of their analgesic efficacy is unclear, but it is thought that they indirectly modulate the opioid system in the brain downstream via serotonergic and noradrenergic neuromodulation, among other properties.[12][13][14] They are also effective in migraine prophylaxis, though not in the instant relief of an acute migraine attack.SOURCE
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Due to the sedative side effects and availability of newer SNRI's that essentially work the same way, TCA's are being prescribed less these days.

I agree with you C.H though, they are not the BEST for sleep issues (especially since for some like me, they produce restlessness like diphenhydramine) but they do work very well for others.
 
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Thanks guys!

Captain, I actually thought the title of my thread would seem pretty odd to all BL'ers because, once I did a little research myself, it didn't stand out straight away that the drug was used for chronic pain issues. My doc said he had a few other patients with similar issues to me and had some success with it and, because i've been seeing him for years, he asked me straight out if i'd try it. He explained it was an Antidepressant so I was a little surprised, but at this stage in the game, i'm willing to try anything if it'll help.

Chronic pain at my age(25) and having basically no cure for it apart from "bucking up and taking it" is quite stressful, as I know it is for many of you guys, so I thought the question would be best asked to people who are in the same boat as me, because I don't think anyone would fuck me around.

I'm having surgery in a couple of weeks so i'm keeping my fingers crossed that it might help ease it up a bit but who knows! At least my doc is honest with me and will script me anything if i read about it, or he'll offer me anything new if he thinks it will work, so at least that's something to lessen the stress of my pain.
 
barnstable84 said:
Thanks guys!

Captain, I actually thought the title of my thread would seem pretty odd to all BL'ers because, once I did a little research myself, it didn't stand out straight away that the drug was used for chronic pain issues. My doc said he had a few other patients with similar issues to me and had some success with it and, because i've been seeing him for years, he asked me straight out if i'd try it. He explained it was an Antidepressant so I was a little surprised, but at this stage in the game, i'm willing to try anything if it'll help.

Chronic pain at my age(25) and having basically no cure for it apart from "bucking up and taking it" is quite stressful, as I know it is for many of you guys, so I thought the question would be best asked to people who are in the same boat as me, because I don't think anyone would fuck me around.

I'm having surgery in a couple of weeks so i'm keeping my fingers crossed that it might help ease it up a bit but who knows! At least my doc is honest with me and will script me anything if i read about it, or he'll offer me anything new if he thinks it will work, so at least that's something to lessen the stress of my pain.
Click to expand...

I understand that a lot of pain patients will never be able to undergo surgery, because surgery specifically on the spine is very risky.

I am glad that you have the option of surgery, and also are trying new treatment options. I hope this one works for you. :)
 
Hell me too! My surgeon says that he can't do anything that will completely eradicate my pain and that 'going in' may not do anything unless there is a new specific injury or they've found a tendon or ligament has been really damaged. The Op in a couple of weeks are to check out my other leg, the good one, because all of the strain from the last 13 years, plus a couple of other injuries, my kneecap is maltracking and tearing. They're going in to see if they can repair it or they'll be doing a graft to counteract the slippy kneecap.

I'll be up for total knee replacements as soon as i'm old enough. Right now, they refuse to do anything that drastic unless its ABSOLUTELY necessary because artificial knees have a short lifespan.

Anyway, I really appreciate your feedback and thanks so much. This community is amazing, it's great to be able to just ask you guys without pointing the finger at me or thinking i'm a drug seeker or anything. I think, as long as you're not hurting anyone, if you find something that works, stick to it until the cons outweigh the pros. I'm not really judged and that feels great to know.
 
@captain.heroin- for many like myself, the damage to the peripheral nerves is the cause of the pain and there aren't surgical procedures that can correct this. For a select few, radiofrequency lesioning and nerve ablation are options but these have limited success.

OP, if you don't mind sharing, what exactly was damaged in your injury and what type of surgery are you having done?

barnstable84 said:
Anyway, I really appreciate your feedback and thanks so much. This community is amazing, it's great to be able to just ask you guys without pointing the finger at me or thinking i'm a drug seeker or anything. I think, as long as you're not hurting anyone, if you find something that works, stick to it until the cons outweigh the pros. I'm not really judged and that feels great to know.
Click to expand...

Bluelight truly is an amazing community, in regards to pain management, being a member has changed my life in a number of ways.

"stick[ing] to it until the cons outweigh the pros" is a brilliant philosophy, the only problem is a select few get into deep and are unable to move on despite the cons.

You seem to have a great attitude and please let me know if you have any questions about pain management... I've been studying every therapeutic procedure, every etiology of pain, the pharmaceutical and alternative options, etc. for years and I truly want to help in any way that I can.

take care
 
Cane2theLeft said:
@captain.heroin- for many like myself, the damage to the peripheral nerves is the cause of the pain and there aren't surgical procedures that can correct this. For a select few, radiofrequency lesioning and nerve ablation are options but these have limited success.

OP, if you don't mind sharing, what exactly was damaged in your injury and what type of surgery are you having done?



Bluelight truly is an amazing community, in regards to pain management, being a member has changed my life in a number of ways.

"stick[ing] to it until the cons outweigh the pros" is a brilliant philosophy, the only problem is a select few get into deep and are unable to move on despite the cons.

You seem to have a great attitude and please let me know if you have any questions about pain management... I've been studying every therapeutic procedure, every etiology of pain, the pharmaceutical and alternative options, etc. for years and I truly want to help in any way that I can.

take care
Click to expand...

Oh wow, that is so good of you to offer help like that. I might have to hit you up if amitritpyline doesn't work and if tramadol becomes less effective over time. I really would like to have a chat with you about your suggestions :)

The injury was sustained from a car accident that my whole family were involved. The damage was de-gloving of the lower part of the tight, over the knee, but not much further. It took 4 surgeries to pick out all glass, grass and dirt, then had huge skin grafts from my other leg open the wound. Alot of muscle and tendons and ligaments were badly damaged and the wound looked like i'd been bitten by a shark. I spent so much time in hospital, but I was just happy I survived it as well as not losing my leg. I've had about 15 operations since the operation 12-13 years ago. Had a full reconstruction and tendon graft to stabilise my damaged ACL and then another op to have the metal pins out because the plug loosened and kept catching on what is left of my thigh muscle.

No point dwelling on something you can't change. I'm actually quite positve about the scarring and stuff, even though the pain is sometimes really super frustrates me. The surgery at this stage is just an arthroscope to tidy it up in there and also to see whether I need to have the patella maltracking surgery (cant remember the exact name for that surgery.) This will mean 6 weeks in a straight leg zimmer brace (again, this doesn't worry me, if it works, i'll be stoked though)

Would uploading a photo of the scarring on here without getting in trouble or anything? I know most wouldn't want to see it, but i know there are others out there who'd wanna see hehe..
 
barnstable84 said:
Oh wow, that is so good of you to offer help like that. I might have to hit you up if amitritpyline doesn't work and if tramadol becomes less effective over time. I really would like to have a chat with you about your suggestions :)
Click to expand...

If you keep posting on here when you hit 50 posts you'll reach BLer status and will be able to PM people. Until then, in my profile I have my email and IM so you can hit me up with those any time. I know what chronic pain is like and so if I can help at all, I definitely want to.

barnstable84 said:
No point dwelling on something you can't change. I'm actually quite positve about the scarring and stuff, even though the pain is sometimes really super frustrates me...

...This will mean 6 weeks in a straight leg zimmer brace (again, this doesn't worry me, if it works, i'll be stoked though)
Click to expand...

You really do have an awesome attitude/outlook. I was incredibly depressed about my lot for a while and anxious about the future but I've come to a point where I've accepted this and largely moved on. Its like a weight has been lifted off and I can put all the pain stuff out of the front of my mind and focus on other things, while still dealing with that I have to at times.

barnstable84 said:
Would uploading a photo of the scarring on here without getting in trouble or anything? I know most wouldn't want to see it, but i know there are others out there who'd wanna see hehe..
Click to expand...

It wouldn't be against the rules to post that pic but please make sure you put it in NSFW tags and warn people what it contains so they don't open it unsuspectingly.
 
Good to hear that you are willing to do what it takes to deal with your pain! I took amitryptiline for years to combat migraines. Lots of folks complained about its sedative effects, but 100mg doses never sedated me. The biggest thing I noticed from it was dry mouth. When my dentist started noticing the problem, I asked for something else.
 
I know somebody who swears by using Amitriptyline for nerve pain. As far as dependance goes, Its not going to be like an opiate type of addiction but when you stop taking the med you have to taper down gradually. Hey good luck i know that nerve pain can be really horrid hang in there
 
barnstable84 said:
Hi Guys, long time no post!

I've just been prescribed Endep (Amitripyline) for pain. The backstory is that I was in a car accident when I was young and almost had my leg ripped off. Long story short, I ended up on Tramodol 100mg SR, 1 tab twice a day.

It was working really well for me until I started finding it was "gearing" me up and making me feel all speedy. This lead to me being unable to get good sleep and was then prescribed Stilnox (zolipidem) to counteract that. It works brilliantly for me. I used to mildly abuse the zolipidem but have moved past that now.

Anyway, the doc suggested that Amitripyline could help stop pain signals and may also work on the sleeplessness issues altogether. He gave me the 10mg tabs and said to just stop if the side affects are worse than the benefits.

I've done a bit of research here and see the following:



Are there any BL'ers out there who have become dependant on this drug or an experience on anything I might need to know that's not explained in the AntiDepressant Mega Thread? My Doc did say that it may not help the pain side much as most of my pain may not be nerve pain, but that it might be good for the sedative affect.

I also want to know if there is anyone out there who has had both tramadol, promethazine and the zolipidem and Amitripyline together with adverse side effects that were different to the explanation above? I'm not taking all at the same time, but they are all something I do use often and just want to cover my bases. I really don't want to fuck myself up on it if it's not going to really help with my pain issues.

I'm not game to try it until I find out!

Anyway, feel free to kick me out if i'm asking silly questions and I appreciate any feedback i'm given :)
Click to expand...



TCA's for pain are...good if they work I suppose - depending of course on the side effects.


I'm surprised you were not prescribed Nortriptyline, its just like Amitriptyline, except its (2nd?) generation ...IIRC there are 2 generations of them. Same TCA benefits, yet more tolerable by patients, aka; less side effects, and just as efficient.
 
I'm surprised you were not prescribed Nortriptyline, its just like Amitriptyline, except its (2nd?) generation ...IIRC there are 2 generations of them. Same TCA benefits, yet more tolerable by patients, aka; less side effects, and just as efficient.
Click to expand...

Ooh, I might do some research on that.. Thanks for that, i'm new at this type of treatment, i've never had my doc suggest it could be nerve pain so the amitriptyline is the first given to me.

I had some last night (20mg) and I feel like shit today. I have a relative who is on it and they have the same issue. Does this feeling get better as my body gets used to the treatment?
 
Cane2theLeft said:
It wouldn't be against the rules to post that pic but please make sure you put it in NSFW tags and warn people what it contains so they don't open it unsuspectingly.
Click to expand...


Ok, just for background, this is the major cause of my pain. I also suffer from the slow but steady weakening and degradation of my other knee joint due to the stress. Beware, it's not pretty!

NSFW:
P8060461-1.jpg


NSFW:
P8060458.jpg


Gnarly huh? I don't want to offend anyone by making fun of my scars because I know other people have them who aren't ok with them, but i look at mine and think how cool it is i'm still here and that I could be much worse off. Plus, I can tell the story and teach people that cars aren't 100% safe and that speeding kills or maims.
 
Chronic pain blows! I was 19 when an SUV tried to make a red light and hit me while I was riding my bike. Long story short, my back is all fucked up now. I tried everything I could to help with the pain, because I have 2 herniated discs, an impinged nerve and my discs are degenerating really quickly now. Surgery is not an option anymore for me.

Just try everything you can, because when it comes to opiate painkillers, addiction is a huge possibility. I got caught up in it and I still shoot up and smoke my Fentanyl patches that my pain doctor prescribes me, but that's my problem which I've tried to get help for, but addiction is a bitch. I started on Tramadol, then went to Vicodin, Percs, then Opana ER, Dilaudid and Oxy. That got me going really well, just sucks when the pain comes back.

Good luck brother, hope you get the help you need and deserve!
 
Thanks so much.. I didnt actually think fent was available here in Australia. If my pain begins to worsen and tramadol doesn't cut it anymore, it's something worth trying, although i'm terrified to try it based on some of the scary stories i've heard and read in the case studies posted. Especially trying to shoot fent patches and losing a limb! I nearly lost a limb once, don't need to fucken do it again! I'm a novice when it comes to shooting of any kind. Plugging is enough for me!

Another thing i'm worried about is the fact that i'd like to get pregnant soon and I don't know how the extra weight will work on my injuries (i also had a severely broken pelvis during the same accident and it means i may not be able to have a natural birth) and also the pain meds and everything i'm taking would affect the baby. I've researched a bit and have found alot that say its ok to use while pregnant, but I just don't think I could do that in case i harm the baby. My aunty was a speed freak and smoked 10-20 cones a day when she was pregnant with my cousin and he's disabled.
 
i've had RA for 20 yrs. chronic pain and sleep disturbances have been a long term problem. i take 25mgs of amitriptyline, have found it to be very helpful for restorative, restful sleep w/out hangover side effect in the a.m. decent sleep helps the battle w/ pain in itself.
best of luck to you.
-izzy
 
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