Anti-depressants for chronic pain?
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kissproofwor ...@yahoo.com
Does anyone here take anti-depressants (or can point me to studies) for chronic pain? Any AD's that are not tricyclics? Has anyone tried, for example, Effexor? My psychiatrist told me there is evidence it's good for pain. Has anyone tried Prozac for pain? Does anyone know of studies that compare various anti-depressants and their effects on pain?
I know, a lot of questions, sorry.
I'm back on the neurontin and having trouble with the addled brain thing. It isn't tired; it's really brain-not-working. I'm going to have to stop taking it I wish I didn't get this as so many others here seem not to. I am on a teeny dose.... very sensitive to meds.
Any info about anti-depressants and pain much appreciated.
- Jen
Adrian adrian_tur...@hotmail.com
I couldn't tolerate neurontin, either. I found topomax much more helpful for migraine prevention, with less bad side effects..
Adrian Turtle sidewalk radical
kissproofwor ...@yahoo.com
I'm curious, which side effects did you not get from Topomax that you got on Neurontin?
"Editor" Editor7...@hotmail.com
I have spondylolisthesis (lower back pain) and have been taking Prozac (for depression) for about 12 years. It never touched the back pain. Finally last year I started on Norco (hydroconone/apap) and it has helped tremendously.
Editor ...
"Teri Robert" headaches.gu...@about.com
Jen, Many antidepressants are used for Migraine prevention. I started with Effexor XR a couple of months ago, and it is helping. My neuro is about to increase the dosage. As for using AD's for other pain, that, I'm not sure of.
Teri ...
Adrian adrian_tur...@hotmail.com
Fatigue, confusion, sleepiness, disorientation, nausea, and spectacularly severe dizziness. My doctor insists that there are two unrelated kinds of dizziness - the kind of light-headedness you get from low blood pressure or low blood sugar, and the vertigo you get from motion-sickness. They feel the same to me. I had lots of both. I had lots of both ALL THE TIME, when I was moving, when I was standing still, and when I was lying in bed. Neurontin gave me no relief from migraines, or any other pain. My doctors tried to claim that the sedation was good for me, but it wasn't making me sleep well...I slept a lot, but the dizziness would wake me every time I rolled over in bed (I was afraid I was about to fall out.) Topomax does not give me milder versions of the same side effects.
It gives me completely different side effects, which are less bad.
With Topomax, I have have weight loss, insomnia, anxiety, and depression. The weight loss is only a nuisance, not really bad.
The insomnia and anxiety are moderately upsetting....I take valerian, and yell at people. The depression is more worrisome, but I do not have a very bad case of it. Anyhow, since I started taking Topomax, I still have daily migraines, but they are much, MUCH, less severe. The side effects are definately worth it for me.
Adrian Turtle sidewalk radical
"Lesley Swain" alison.les...@virgin.net
I've been taking ADs for a while now and coincidentally had Peripheral and autonomic neuropathy.
The Tricy.s didn't touch the pain, neither did neurontin, chlorpromazine, Seroxat (Paroxetine) and Effexor XL - all at max. permitted doses.
Everyone's different so it's always worth persevering.
Lesley xxxxxxxx ...
Mary9 ...@webtv.net
No, I suffered for 2 years while my GP tried every AD on the market. My pain is neuro-muscular and joint pain. My doctor mistakenly believed that it would help.
It did not, none of them. Interestingly, the 'off the market' phen/fen actually did seem to decrease my pain. I was on it for 3 months before it was pulled, in an effort to lose weight, with no expectation that it would effect my pain.
The relief was incomplete, but undeniable. It may be from reports like this, from drugs that work in somewhat the same way, that the doctors came to believe that other SR's would help. It may have been the combination, it could have been one phen or the other fen, but something worked. Trouble is, how can one rx that changes brain chemistry work on everyone in the population with no way to measure. Then they tell you to expect no change for 60 days and you find yourself suffering, having lost another two months of your life to pain. When that doesn't work they give you another and tell you to wait another two months for effect.
It's just a delay that doctors who won't rx opiates use to keep you coming back with hope, until you tire of the game. Unfortunately, outside of opiate relief, the only other medical advice i got that really mattered was to correct an interrupted sleep pattern.
Flexeril at bedtime works for me.
Don't ever forget the simple stuff that we often overlook, like hot packs and ice packs, it can really help, for a short time anyway.
M.
"And there were those for whom there was no memorial. It was as if they had never been."
kissproofwor ...@yahoo.com
Hi Sandy, Thank you and everyone for the reply; I suspected it was something like you wrote, but hoping there were genuine pain relieving properties to AD's.
I can't quote studies anymore but a remember from grad school a long time ago statistics about sick days and depression. People with depression took far more sick days than the "average" person - not due to faking illness but due to getting more sick or feeling more pain (lower immune response... and now I forgot what else).
I can see how it could work in that direction - feeling bad emotionally, feeling bad physically.
I've not found pain relief through psychiatric medications, and I'm wondering to what extent it does work in reverse - severe pain from major medical conditions lessened through the use of anti-depressants.
I know that at moments I'm feeling very good, having a good time, sometimes I feel less or no pain but I pay after. It's as though endorphins override pain sensation but my body feels it the next day as it would if I overexerted myself on any day.
I'm not doubting your hypothesis below in the least, just thinking it through. Also, I am depressed and in a way I do think I'd be in less pain if I were less depressed - though I don't want that to reek of the "in your head" notion I've heard too much of. I get your point below and it's well taken. I'm so glad Effexor is working for you and I think I will try another AD to see what happens on both fronts...
though, oh, the side effects.
Anyway I've rambled. Thanks to everyone who replied to my question.
Jen On Fri, 19 Apr 2002 23:14:47 -0400, "SandyG."
dcrear ...@aol.com (DCReardon)
Exacty right Mary 9878, because of the WOD mentality in the world, docs are so afraid to prescribe the meds that DO work, instead subjecting patients to month of "trials" of useless and expensive anti-'d and anti-seizure meds, when in fact a proper dose of opioids would do the trick.
And it seems to be getting worse. the pharm companies are making fortunes on stuff like prozac, paxil, etc, and I recently read a study where 50% of the participants got the same relief from a placebo!!
And we do not know the long term effects of these brain drugs. More and more reports of the difficulties that patients have tapering, even though the medical professionals say these meds are "not addicting".
Opioids have been around for centuries and are relatively benign, albeit some annoying side effects.
These brain drugs do not have a long track record, in fact most of the "diseases" that they are prescribed for did not even EXIST 10 years ago. Its like the pharm companies make up these desease so they can sell more expensive meds!!
sheldonal ...@ca.inter.net
According to Scott Fishman, M.D. in "The War on Pain", the tricyclic antidepressants (Elavil , Amtripytline, Nortriptyline etc) work on neuropathic pain as antiarrthythmic drugs - drugs that smooth out the nerve firing.
I've got an unusual spinal nerve injury. I find that a dose of one of these drugs , currently Nortriptyline, is the only thing that stops me from having jolts of electricity run up and down my legs.
Each of the tricyclic's had different side-effects and may or may not be more effective for a patient. You might consider a trial of a number of them -- increasing the dosage as needed. Fortunately, some of these drugs are very cheap. Best wishes
Jamie ja...@nowhere.com
There are for some people, it seems to depend very much on the kind of pain you have and your personal reaction to the different meds.
Certainly the tricyclics are known to work well for a lot of people.
I have a prolapsed disc in my lumbar spine. At times I've been given morphine, pethidine and various heavy codeine derivatives (DF118 works well) but I desperately don't want to take the really heavy stuff regularly as I'm looking at possibly another 30 years of life, and for so many people such addiction becomes a bigger problem than the pain.
Basically I try to take as few meds as possible to make each day liveable. I take the maxiumum possible dose of DICLOFENAC ("Diclomax SR" anti-inflammatory 75mg x 2 ) each day regardless. Without that I can hardly move. Then, depending on how bad it is I also take something like distalgesic or kapake four times a day. If all I'm doing is sitting at my PC all day, in a good chair, then co-codamol 8/500 can be enough to make it bearable.
I tried the tricyclic antidepressants dothiepin hydrochloride and amitriptyline, and although they were certainly effective, they were too sedating for me. They're known to have a sedative effect, which is often required for depressives, but didn't work for me. Having said that, I know several chronic pain sufferers who find them marvellous and who aren't sedated by them. It depends on each individual's response to them.
It was my GP who suggested I try fluoxetine (prozac). Because the tricyclics had worked on my pain he thought it was worth a try. It took about six weeks before I noticed any effect, but then I suddenly realised that I had been able to spend 20 minutes walking round the supermarket before I noticed any really bad pain in my back. Before fluoxetine I was in agony after 5 minutes. Now 20 minutes may not seem much to most people, but to me it was a miracle. After 2 months I found that I could actually walk my dog for half an hour before it became too painful to remain standing. I haven't been able to do that for years.
The fluoxetine also dulled the constant ache to a certain degree, so when sitting it's not so bad either now.
I would question Sandy's statement that "Anti-depressants do not actually decrease the pain itself - rather it decreases our PERCEPTION of the pain", because every doctor I've spoken to, including the pain management specialists, tells me that nobody is certain how ADs work for some people or why they don't work for others. One of the doctors I work with told me that there are studies going on into whether it might be that because they affect the chemicals in the brain and hence central nervous system, that they actually block the pain receptors in some way. It might be that by lessening the depletion of seratonin the body processes the pain more efficiently. It might be that it just gives you a bit of a "lift" and so you deal with the pain better on an emotional level. The truth is that none of the experts appear to know, it's all conjecture.
The fact is that ADs *do* work for some people. I know someone for whom amitriptylene works well but fluoxetine doesn't work at all. I know another for whom fluoxetine has a marked effect, but the tricyclics don't. Being a born sceptic I didn't expect ADs to work on me at all, and I was very surprised when they did. To be honest I rather hoped they *wouldn't* work because of all the AD horror stories I'd heard, particularly about fluoxetine. Frankly, now, I couldn't care less *why* they work, the fact is they do, and I haven't had any side effects at all. What fluoxetine's done for me is allow me to keep away from the really heavy pain meds, which I don't want to use unless I absolutely have to, and I don't feel affected by this medication in any way other than that my pain is less. I doubt that fluoxetine would ever replace all other pain meds, it's much more of a complement to them. Prozac isn't "liquid sunshine" in the sense it's often used about depressives, but then I wasn't clinically depressed in the first place. I certainly feel much better in myself since taking it, but that's because the pain is better and that makes life much more enjoyable. Just to be able to walk across the fields with my dog is wonderful. What I haven't experienced is the "high" or "euphoria" and so many depressives say means that fluoxetine is changing their personalities. My friends tell me I'm back to the way I always was before I was in so much pain, not that I'm different.
Certainly, if you're suffering from depression as well then I'm sure fluoxetine would help because I've seen other pain sufferers say it's helped them. I used to get very down and fed-up because of my pain, sort of "Oh God I can't cope with this any more....", but having read some of the depression NGs I now realise that I was never clinically depressed as people there are. Clinical depression is quite clearly a horrible condition and I never suffered the depressive symptoms those pour souls suffer.
I ran search engines on "fluoxetine +pain" and "Prozac +pain".
Thousands of things came up. From what I read it seems that not all pain responds to this medication. For example, in the studies I read fibromyalgia sufferers often find it works for them, but diabetic neuropathy sufferers don't see to get any relief from it. How much it depends on the cause of the pain and how much on each individual's unique reaction to it I don't know, but it's made enough difference to me that I'd recommend you try it to see if it helps you too.
I'd suggest you run some searches and just read what you find. There's m***es of stuff out there and it's a fascinating read.
Jamie
"Katharine S" kathne...@nospamoptushome.com.au
<snipped rest> As I'm sure you'll hear from other people in this newsgroup - addiction is *not* an issue for the vast majority of pain patients on opioids. They are safe to take in the long term - certainly much safer most anti-inflammatories! Did you know that complications from non-steroidal anti-inflammatory drugs (NSAIDs) are responsible for 16,500 deaths in the US each year?
I hate to see pain sufferers try just about everything *but* the medication that is probably the safest and most appropriate one to take for pain, just because of the media beat-up about drugs like oxycontin, and the ignorance of doctors!
In terms of the 'addiction' issue, here's some info on what it actually means, and the difference between that and dependence. I hope this helps.
New England Journal of Medicine: "It is estimated that the risk of psychological dependence while a patient is taking opioids for medical reasons without previously having taken opioids is in the range of 1000 to 1 or less." Fom http://www.ampainsoc.org/advocacy/opioids2.htm : Physical Dependence Physical dependence is a state of adaptation that is manifested by a drug cl*** specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
Addiction Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may "clock watch," and may otherwise seem inappropriately "drug seeking." Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated.
Physical dependence on and tolerance to prescribed drugs do not constitute sufficient evidence of psychoactive substance use disorder or addiction.
They are normal responses that often occur with the persistent use of certain medications.
--
Katharine S.
Everyone has a photographic memory. Some just don't have film.
"jigo" j...@xxx.com
From what I've read and experienced myself, it's a small minority. And the side effects are pretty miserable, even with the best of the tricyclics.
The other antidepressants have a better side effect profile, but are not as useful for pain--sertraline *gave* me headaches.
Addiction is not a major problem for pain patients--tolerance sometimes is.
...
Yes, sedation is a common effect with the TCAs; but even after I found one that wasn't sedating (doxepin), it still had a lot of uncomfortable side effects--blurred vision, constipation,...
Jamie ja...@nowhere.com
spoken to, it's quite a large number, particularly among certain conditions. Before I tried ADs for pain I did hours and hours of research, because I never take anything without knowing exactly what it is, how it works, and what effect it might have on me. My searches produced a number of studies which suggested that certain kinds of pain respond particularly well to ADs. There was certainly enough evidence for me to think it was well worth a try - and thank God I did, because it worked for me.
Oh dear, I do hate these sort of sweeping statements, because each of us can only speak for ourselves. Certainly the side effects *can* be quite bad for some people, but *some* is the operative word. I have spoken to many people who get little or no side effects from the tricyclics. The only side effect I got was that they made me sleepy, I didn't get any other problems with them at all.
It's the same with fluoxetine (prozac). Some people will tell you that fluoxetine has given them side effects they're not prepared to tolerate while others will tell you it hasn't given them any. The only side effect I experienced was a feeling of slight anxiety for a couple of days two weeks after I started taking it. That went off quickly and since then the only way I can tell I'm taking fluoxetine is by the fact that the pain is much improved.
I don't doubt it when you say that sertraline gave you headaches, but I'd bet that there are people for whom sertraline is great. There's a particular anti-inflammatory that makes me feel absolutely lousy, and an antibiotic that I have a violent allergic reaction to. That doesn't mean that both those medications aren't great for other people, and I would never make sweeping statements about them which might discourage others from trying them when they might get relief from them.
I'm sorry, but that's just absurd. Tolerance is a problem in that it necessitates an increase in dosage, but to suggest that addiction is not a major problem when we are constantly reading threads all across usenet from people suffering horrendous withdrawal symptoms and finding it well-nigh impossible to get off major analgesics, is just sticking your head in the sand.
Okay, but that's just *you*. You can't ***ume that everybody will experience the same thing. By all means give people your personal experience so they're aware of what *might* happen, but please don't imply that because that's how *your* body reacted to a particular medication that's how *their* body is going to react too, because there's a good chance it won't.
Jamie
"jigo" j...@xxx.com
It goes without saying that individuals vary in their response to drugs, including the TCAs. But certain cl***es of drugs are noted for their side effects, and the TCAs are notorious in that respect--That's not just my individual opinion; it's what's reported in the medical literature. Sure, it can't hurt to *try* one and see how you react; just don't be surprised if you can't find one without major side effects.
...
Sorry, but citing that kind of anecdotal evidence is absurd for numerous reasons. If you use anecdotes for evidence, you'll end up believing everything from alien abductions to curing cancer with magnets. There were many anecdotal reports of Prosac causing deaths a few years ago (and there still are!). Proves nothing.
Read the statistics that others have posted here: Addiction among pain patients occurs only a very small fraction of a percent of the cases: Friedman, D.P. Perspectives on the medical use of drugs of abuse. Journal of Pain & Symptom Management, Vol. 5, (Supplement), pp. S2-S5, 1990.
Out of 22,000 pain patients on pain medicine, only 19 had ANY problem with "addiction." *** 0.08% occurrence rate *** In yet another study sited by the National Institute on Drug Abuse "Of 24,000 patients studied, only 7 could be identified who got into trouble with drugs as a result of medical administration." *** 0.028% rate *** The main problem in using narcotics for chronic pain is tolerance, which can not only necessitate an increase in dosage but a loss of efficacy.
But it is obvious that anyone's personal experience doesn't mean that everyone will have the same experience. The group is largely about our personal experiences, unless you think we should just cite published studies.
"Katharine S" kathne...@nospamoptushome.com.au
Umm... what you're referring to is not addiction - it's dependence. See my other post in this thread for the difference.
Oh, and by the way, when opiods are tapered off correctly, there are usually minimal problems with withdrawal symptoms. Unfortunately, for varying reasons (usually ignorant doctors), many people are needless suffering when coming off them when being taken off cold-turkey.
--
Katharine S.
Error: Keyboard not attached. Press F1 to continue.
Jamie ja...@nowhere.com
This is a very moot point, and one most usually raised by those taking these medications who insist on maintaining they're not addicted because of the negative social connotations of the word "addicted".
Most professionals in the drug treatment and rehab field use the terms "dependence" and "addiction" interchangeably, it's the patients who try to make the distinction.
Take DrugScope for example. DrugScope is the UK's leading independent centre of expertise on drugs. They promote their aim as being "to inform policy development and reduce drug-related risk. We provide quality drug information, promote effective responses to drug taking, undertake research at local, national and international levels, advise on policy-making, encourage informed debate and speak for our member organisations working on the ground." Right throughout their literature they refer to addicts as being "dependent" and those who are dependent as being addicted.
Take The College on Problems of Drug Dependence in Philadelphia (CPDD).
This is the oldest scientific organization in the United States concerned with research on problems of drug dependence, in their own words "a professional organisation of scientists whose research is directed toward a better understanding of drug abuse and addiction." Read any of the following studies and papers and it is quite clear that when the word "dependence" is being used in the context of addiction.
A 33-year study of heroin addicts by UCLA researchers details "the severe personal and social consequences of dependence on the drug, and the heavy odds against permanent abstinence from heroin by long-term addicts".
'For many heroin addicts, dependence on the drug has become a lifelong condition ***ociated with severe health and social consequences,' said Yih-Ing Hser, adjunct professor at UCLA's Neuropsychiatric Institute and the study's principal investigator.
"Differences in severity of heroin dependence by route of administration" by Gregorio Barrio, Luis De La Fuente, Carola Lew, Luis Royuela, Mar?a J. Bravo, Marta Torrens.
"Double-blind comparison of carbamazepine and placebo for treatment of cocaine dependence" by I.D. Montoya, F.R. Levin, P.J. Fudala, D.A.
Gorelick, "Psychiatric symptom severity in cocaine-dependent outpatients" by J.W. Tidey, L. Mehl-Madrona, S.T. Higgins, G.J. Badger, and clinics: "The Alexander Clinic provides a specialised treatment programme designed to meet the needs of those who suffer from alcohol, drug and gambling dependence. The programme approach is holistic, addressing the physical, mental, psychological, social, moral and relationship implications of addiction." Not according to all the scientists who've written these and other papers: "Opioid addiction - Predictors for completing an inpatient detoxification program among intravenous heroin users, methadone substituted and codeine substituted patients" by Markus Backmund, Kirsten Meyer, Dieter Eichenlaub, Christian G. Sch??tz.
"Needle sharing in opioid-dependent outpatients" by Amy L. Odum, Gregory J. Madden, Gary J. Badger, Warren K. Bickel.
"Fluoxetine treatment of depressive disorders in methadone-maintained opioid addicts" by I. Petrakis, K.M. Carroll, C. Nich, L. Gordon, T.
Kosten, B. Rounsaville.
Please don't misunderstand me, I'm not in any way criticising those who choose to use opioids, I may end up using them myself. If that's what chronic pain sufferers need there's no reason at all that they shouldn't use them. I just wish that society was able to distinguish between recreational use and necessary medicinal use of addictive drugs so that those who have legitimate use for them could be honest about it without fear of stigma.
Jamie
Jamie ja...@nowhere.com
Very probably, but then safety wasn't the issue in question here.
Because something is addictive doesn't mean it's unsafe, or that people who need it shouldn't use it. If someone needs these drugs they should take them, I just prefer not to at this point.
The problem with our society is that we have become so drug addiction fixated that we're unable to see that addiction in itself is not something to be castigated. It's why you take something and how responsible you are in its application that's relevant, not the addictiveness of the drug per se.
No, but then I don't live in the US, so it's unlikely I'd know that.
What I do know is that they are believed to be responsible for around 2,000 deaths in the UK each year. A number of those will, of course, be due to the patient not taking the medication as recommended, which will make GI bleeds far more likely.
Certainly many patients with related conditions are elderly, and the stomach lining of the elderly is thinner than that of the young and so is more vulnerable to NSAIDs. While it is never possible to exclude the possibility of NSAID-related gastric conditions, it is possible to lessen the likelihood by always taking the medication in the recommended manner, and by the use of gastric protectors.
I wouldn't for a moment suggest that taking any of these medications is ideal or without risk. It's a matter of personal choice as to which we take. My choice is not to take something that I know I will become addicted to at this point in my life. I take precautions against side effects from the NSAIDs - which may or may not protect me long-term, but it may well be that in the future I will change to opioids. All I'm saying is that when I do I won't pretend that they're not addictive.
Jamie
Codeee Cod...@Bigmailbox.net
Unfortunately, I think you've hit the nail on the head Jamie.
The very reason medical people and patients are insistant upon using words like opiods instead of narcotics, and dependance instead of addiction is because of the very real societal stigmas attached to these words.
Since we're a very long way from changing these attitudes, we have to make people see that there is a difference between someone dependant upon their opiod medication, just as a diabetic is dependant upon insulin. Please do not say that the diabetic will die without insulin, and the opiate dependant patient doesn't face death without pain control, far too many people have died without pain management for that to be a completely accurate statement.
codeee
Jamie ja...@nowhere.com
As someone who works in a medical environment I have to say that I've never known a doctor who distinguished between dependence and addiction when talking about opioids. It's the patients who feel they have to make the distinction when showing their public face - but most admit they know they're addicted in the safety of medical confidentiality.
That is such a sad situation, as if chronic pain sufferers didn't have enough to deal with without having to worry about society's sensitivities. The shameful thing is that the medical profession isn't more vocal in dispelling the stigma attached to opioid use for pain relief.
I would qualify that statement by saying "there is a difference between someone dependent upon their opioid medication for pain relief and someone dependent upon it because they are abusing it for recreational use".
I think it's a bit tricky to compare opioids with insulin. It's not about whether or not the patient will die, it's the nature of the body's reaction to removal of the medication. The diabetic is reliant upon insulin in the sense that without it his body is not able to function.
Insulin is the fuel on which his body runs - take that fuel away and the body grinds to a halt. He needs insulin to survive, but his body is not addicted to it - much like we all need water but water in itself is not addictive.
That's not the situation with opioids and is not what happens when opioids are removed. Someone on opioids is addicted, whether they want to admit it or not. If they stop taking the medication it's not just that the pain the medication is being taken to overcome will return, but that person will display and experience true addiction withdrawal symptoms totally unrelated to the pain and solely connected to the removal of the drug. That's the difference.
Again, let me emphasise that I'm not saying we shouldn't use these drugs
- just let's be unashamedly honest about them.
Jamie
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