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Nortriptyline - nerve pain or depression (have I been duped?!)

13 replies

PavlovtheCat · 22/01/2014 21:18

I have sciatic nerve pain.
I have been to see the nurse practitioner at the pain clinic to chat about medicines and making sure i have best combinations.
I filled in one of those forms about pain levels, coping levels etc. My scores were largely 6+, averaging 7. Clearly, emotionally pissed off.
Discussion with nurse, got to fill in a sheet outlining where my pain is, on a diagram.
Patronised a little. Asked a few questions about my sleep. Asked if I have ever been prescribed anything to help with my mood or with my sleep. No, I said, not directly for those reasons but have tried amytriptyline, very sensitive, couldn't cope with side effects so stopped. Brilliant said the nurse, in that case, we can try nortriptyline, as it's similar but more gentle than Amytriptyline.
Discussed possible side effects, taking with other medication. I asked if i should stop taking certain other meds as she was not happy with me taking anti-inflammatories over a long period, and she said (para) 'don't change your current dosing pattern now, wait for a little bit and when you start sleeping a bit better, and feeling a little bit better in yourself as the medication works, then you can think about changing those'.
She did say this was not because she thinks I am depressed, but it feels very much that this is what it's been prescribed for. As she spent more time talking about how my mood will feel better, not, as I had thought it was being prescribed for, that it will help my nerve pain.
Now, I am not necessarily adverse to a little mood enhancing as a side effect. I am certainly prepared to consider that I am little depressed. But, the reason for that depression is due to constant bloody pain, not due to issues with chemical imbalance, so the priority for me is to address the pain, and then the depression will do one. In fact, I would go so far as to say, rather than depressed, I am fed up with constant pain.

But, I would prefer that the nurse said to me 'Mrs Pavlov, this is an antidepressant. You are depressed, as indicated by my cursory glance at your scores without even discussing the answers with you I feel this will improve your mood and thus your ability to cope with the pain you feel accept your lot.

So, what I would like to know is really - have you been prescribed this for nerve pain, did it work, how well did it work compared to other nerve pain targeted drugs, have I been duped and this is fact a through-the-back-door way of prescribing me ADs. How does the pain relief compared to side effects, what side effects did you have, how bad, and anything else I should know about this drug (will it make me really constipated? As I had a horrific experience of this on amytriptyline, which i was taking with tramadol which I would prefer not to repeat shall I get the prune juice ready?)

I have taken one now. If it's at all like amytriptyline I will be goofed in 30 mins and unable to wake in the morning. Is this what I should expect?

OP posts:
MedusaIsHavingaBadHairday · 22/01/2014 22:11

Yes it's prescribed for nerve pain. What dose have you been put on? Generally lower doses are prescribed for nerve pain, whereas as an anti depressant doses are FAR higher. For example I was on 25mg initally for pain..as an anti d I think the starting dose was 150mg.

For me it didn't work particuarly well but it didn't have hideous side effects either (and I'm the constipation queen!) Give it a few weeks trial and if it does nothing go back. For me THE nerve pain killer is Gabapentin..I was climbing the walls with nerve pain (Trigeninal Neuralgia) and it worked. However the dose I was on would have knocked out a moose I think !

Hope it works for you :)

PavlovtheCat · 22/01/2014 22:25

medusa oh, that's good to know. I was wobbling as she spent so much time talking about my 'mood' but not actually talking about it, or else I would have told her how I was feeling.

10mg. She said this was a low dose to start, with view to increasing it a little if it worked well. She didn't say how much to, but the sheet I was given about it suggests, 30-50mg?

I tried gabapentin. It didn't really work, but I didn't give it longer than 2-3 weeks, as I could not get past the side effects, it DID turn me into an actual goofball. I could hardly string words together, I sounded soooo drunk! I just sort of floated about. But also had nerve pain so was a proper sorry mess. Can't remember the dose, but the lowest dose.

I tried pregabalin. GP gave me a really dose, and titrated it to 75mg. I think I was meant to be on like 150mg for back pain. I could not get past 75mg. It again affected me badly, drowsy, slept much of the time, put milk in the cupboard, coffee in the fridge, couldn't find things, couldn't remember words.

Same with amyptriptyline, but the side effects of that was the worst - couldn't drive as struggled with peripheral vision issues (not eyesight, it was my brain that wasn't computing), Loss of appetite (I lost over 1.5st, went to 7st.7lb), I was asleep by 8pm, couldn't get up in the morning (literally couldn't lift my head off the pillow) constipation (horrific experience, it was dealt with by OOH with what my GP referred to as breaking a nut with a sledgehammer). I can't remember the dose, not high, I think 20mg? Maybe 50mg. I don't think it was higher than that, it was very low. That worked fab for nerve pain, but I could not function At All on it. I couldn't work. I was told by my GP that I had to inform DVLA and my car insurance company I was on it, and that she had advised me not to drive. That ended that after 5 weeks of trying to ride through the side effects.

The GP concluded that I am super sensitive to these drugs hence such strong reactions for so long.

Hence my reservations, along with the nurses keenness to improve my mood Grin

OP posts:
MedusaIsHavingaBadHairday · 23/01/2014 00:04

Ah, I was on Pregabalin initially too. On a huge dose (Trigeminal Neuralgia is a bitch... also known as 'the sucicide disease' due to the excruciating pain. To be honest I'd have eaten mud if they had told me it would help.

The side affects of Gabapentin DO wear off eventually..but it takes a while. I was switched to it once the TN was under control as it's cheaper than Pregabalin, and initially I was on 3600mg a day...max dose... you can imagine what that was like! I remember being at work, going to the loo and seeing little mice in the lino pattern on the floor Grin Now I'm on 300-900mg a day pain dependent (on it for back/hip pain and weird neuro stuff as the TN has gone thank god!) 300 is fine.. 900 and I'm knocked out and can't drive.
Oddly enough I am super sensitive to other meds (can't take codeine etc) but can neck back Gabapentin pretty well.

Really hope the Nortriptyline works for you!!

ouryve · 23/01/2014 00:08

These drugs are more commonly prescribed for nerve pain than depression, these days. I take 10, occasionally 20mg of amitriptyline at night. An antidepressant dose starts at about 80mg.

Weegiemum · 23/01/2014 00:11

I have neuro pain in hands, feet and face due to a demyelinating peripheral neuropathy.

Was started on Gabapentin - zombied me!
Pain clinic tried Pregab - even worse.

So they tried Amitryptaline. My dose is almost therapeutic for depression - typical neuro pain dose is 10-25mg but I'm on 100mg (enlightened doc!) and I'm doing very well on it.

Mood is important - it's a lot easier to deal with pain if your mood is good. But it's also important to feel like the docs are taking you seriously. I know my consultant does. He knows I'm in pain, and listens to my experiences.

PavlovtheCat · 23/01/2014 08:36

weegie the nurse certainly didn't take me seriously re pain. She was keen to get me off naproxen, despite me telling her that it was the one medication that I absolutely notice a significant increase in pain when I stop it. And I need the honesty. I would prefer that she explained, as you have, that actually improved mood makes pain easier to manage, and, yes I know that, but, when it is sort of suggested that the mood is the cause of the pain, it makes me frustrated as I know that is not true. This nurse has only met me once and I am not due to see her again. She has said that i should return to my GP for more meds if it works, or to discuss returning to tramadol if it doesn't work. She was quite dismissive, but also running 20 mins late so perhaps that's why. She certainly didn't me me talk for more than a couple of words about my pain, when she asked what was worse, back or leg pain, she wanted a one word answer, followed by a percentage of split (ie 30/50) and actually it isn't that easy to answer that instantly, she didn't let me finish when I was trying to say that the back is also bad, as bad as the leg pain, but I can manage that better than the leg pain, however would like to see if that can be managed better/differently too. She was not interested.

OP posts:
PavlovtheCat · 23/01/2014 08:39

definitely 'zombie' is the word to describe how those other meds made me feel Grin

I took it last night. I slept terribly thanks to a pain in the backside boy who wouldn't settle, a badly snoring DH. So, it certainly didn't just knock me out. I do feel fluffy this morning and just need to chill out quietly, but I have DS nagging me to show him a picture of a lollipop that he once saw on the internet, at some time in the past. He is going on, over, and over, and over. But, perhaps that annoyingness is nothing to do with the meds Wink

I am glad it is used for nerve pain as well as mood. I will give it some time.

OP posts:
Gigondas · 23/01/2014 08:47

Am on 75mg of Nortrytptiline for nerve pain- it was increased from 25 mg and yes it does make a big difference. Also it doesn't knock you out or make you hungover like other drugs do. It does take a week or two to feel effect,

I also also take gabapentin and it also made me seem drunk when first took it. I notice now if haven't taken it on time so I do think it works.

RudyMentary · 23/01/2014 08:50

This reply has been deleted

Message withdrawn at poster's request.

PavlovtheCat · 23/01/2014 08:54

gigondas that's great to hear about reduced side effects. I was so walloped on the other meds I have been worried about that as I couldn't work on the other meds and I need to get back to work. I feel a little 'heady' this morning, slightly cloudy, but not struggling with words. I remember talking to a HR boss on the first day following taking gabapentin, it sounded like I had been drinking and it was only 10am! I could feel my words coming out really slowly and thick sounding, and quite slurred!

OP posts:
Passthecake30 · 23/01/2014 09:49

I had it for a time to stop me clenching my teeth in the night and getting shooting pains in my head....also made me slightly happier in the process!

Blu · 23/01/2014 09:58

My DS was on Amitriptyline aged 7 for pain during a long orthopaedic procedure. It is a pain modifying drug, good for nerve pain - and not just because of any effect on moods - it actually modifies the bran's perception nerve pain so that you are not sensitive to it - I think! (a nn medic myself).

I know people took Amitriptyline for a compressed disc (or something - squashed vertebrae) and it hugely reduced her migraines, as a good side effect.

Having seen what long term anti-inflammatories for arthritis have done to my Mum (stomach problems) I would do all I could to avoid those on a regular basis.

Sorry you have to cope with sciatic nerve pain.

surgicalwidow · 27/01/2014 00:44

It sounds like the pain nurse knows what she is doing. Naproxen has potentially awful side effects so advice is to only take at the lowest effective dose for shortest possible duration. Like others have said, usual effective dose of TCAs for pain is sub therapeutic for mood. Try codeine / oramorph if your pain is at all opioid responsive but ensure you always take a laxative with either!

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