Kos – the doctor is not crazy prescribing this. Opiates do not help nerve pain. They may zone you out enough so you don’t step in front of a bus to get away from the constant pain, but that’s about it. I have had lots of nerve pain in my life and can tell you that much. Amitriptyline is standard treatment/often best treatment for nerve pain. I’ve taken it and am alive. It did not change my mental state at all while on it. See following:
Many people living with chronic pain are daunted by the prospect of long term or even permanent drug therapy. What are these drugs, are they safe and how do they work? Concerns such as these can stop people persevering with medicines that may offer a real, life-enhancing solution to their condition. Dr Mick Serpell explains how amitriptyline works and gives reassurance about the side effects that you might experience, especially in the early stages
The main aims in managing chronic pain are to relieve or to reduce the pain and, just as importantly, to improve your quality of life and get you doing more. There are four approaches to pain management:
1) physical therapy (physiotherapy, acupuncture, TENS (transcutaneous electrical nerve stimulation), etc.
2) drug therapy
3) regional analgesia (injection of drugs around nerves or other tissues)
4) psychological therapies (techniques which improve coping with pain).
Two types of pain
Doctors describe pain as either nociceptive, neuropathic, or a combination of the two. It is important to distinguish between the two types of pain, as they need different medicines.
Nociceptive pain is pain that starts off as a response to tissue damage or a painful stimulus like a hot surface. Examples include mechanical low back pain and degenerative or inflammatory joint pain, and so it is easy to understand why nociceptive pain is the most common form of chronic pain. Although these pains may begin as purely nociceptive, over time there may be changes within the nervous system that may result in neuropathic pain.
Neuropathic pain may also be the result of nerve damage that makes the nerve overactive. Therefore the drugs used for neuropathic pain are aimed at stabilisation or “calming” of the overactive nerves. Perhaps it should be no surprise that drugs used in other conditions where nervous tissue is overactive or “excited”, such as epilepsy or depression, have turned out to be useful medicines for chronic pain where the nerves have become overactive.
Conventional painkillers such as codeine and ibuprofen are used for nociceptive pain. They are often not effective for neuropathic pain. Most of the drugs used for the relief of neuropathic pain were originally developed to treat different conditions. For instance, amitriptyline is an antidepressant drug but is now probably used more commonly for pain than for its original use. The situation is the same for some anticonvulsant drugs, which are used more frequently for neuropathic pain than epilepsy.
Change your lifestyle
Always remember that the medicine alone will not be enough. While drug therapy can play a major role in the management of pain, changing your lifestyle (such as building up your fitness and getting more exercise), as well as learning to manage and cope with your pain better, are also vital to the successful outcome.
General principles of drug therapy
Your doctor will start you off at a low dose of your medicine and this is increased up to a suitable dosage and taken for sufficient duration until you obtain noticeable pain relief (or experience severe side effects). This procedure of increasing the dose step by step while monitoring the effect is called “titrating the dose”. If there is no relief the drug will be stopped. Your doctor is likely to gradually wean you off the medication over one to two weeks, to avoid potential side effects from sudden withdrawal. If you get partial, but inadequate pain relief, a second different drug can be prescribed in addition.
Once you are on the right dose and drug combination for you then you may continue on the medication indefinitely. You and your doctor may decide that you should wean yourself off the medicines gradually every six months or so to ensure they are still necessary for you.
Most doctors agree that medication for chronic pain should be taken “round the clock” rather than “as required”. It is easier to keep pain at bay rather than trying to control it after it has been allowed to resurface.
The tricyclic antidepressants, such as amitriptyline, are the “gold standard” for neuropathic pain as they are the most effective and best-known drugs for this condition. They can also be useful for chronic nociceptive pain, especially if there is a neuropathic component to it. They appear to work in the nervous system by reducing the nerve cell’s ability to re-absorb chemicals such as serotonin and noradrenaline. These chemicals are called neural transmitters. If they are not reabsorbed they accumulate outside the nerve cell and the result is suppression of pain messages in the spinal cord.
All in the mind?
The way antidepressants give pain relief is completely separate from the anti-depressant effect. The dose required for treating depression is much higher (often over 150 milligrams (mg) a day) than the doses used for pain relief. Also, there are many different antidepressant drugs available that are effective for treating depression, but only a small number are also effective pain killers.
It is important that the patient is given a full explanation of the rationale for antidepressant therapy. It is not that the doctor believes your pain is due to depression. So do not think that you are not being taken seriously and that the pain is “all in the mind”.
Of course, depression can occur with chronic pain, but it is usually an understandable reaction to the pain and improves as the chronic pain improves. However, if severe, it too may require treatment with an antidepressant drug.”
After the surgery – have him do what Namelus suggests or it will come back eventually. IMO HTH