Pain relief not working

Hello Matron, I have spoken to you before about Nefopam. I take Nefopam, Naproxen, codeine and Gaberpentin. I have taken Amitriptyline In the past for Osteoarthritis. I remember having to go to a higher dose 50mg to get relief and to be able to sleep. I don't take It now due to feeling tired most of the day. I am finding the Codeine helps me with the pain at night and sleep. I do still get nights where I find It difficult to sleep. I am now having pain all the time In my right knee now and am awaiting a consultant, I suspect Osteoarthritis as I have It In my left knee and spine. Have you tried Gaberpentin? My GP as also prescribed me Pregabalin thou I have been reluctant to take It due to side effects. Our bodies get used to a certain dose and we then require higher doses to get the same effects. Viscious circle.

Elizabeth

 

Hi Matron, I am also taking 20 mg Amitriptyline at night, and 30 mg codeine/500 mg paracetamol as pain relief.   I have been on these for several years, and I am now thinking that they are beginning to have less effect, the pain just doesn't go away now.   I am working up to going back to my G.P. - I've been putting it off because they are not terribly sympathetic to (a) arthritis and (b) my age.   However I will see them at some point.   Good luck with it all.

I had a spell of bad pain a couple of years back. It was severe and uncontrollable. It started out that it only hurt when I lay or sat still. When I was moving it was fine. But on a couple of occasions I 'tweaked' something resulting in a few days of unimaginable pain. The pain then started to be constant and severe 24/7.

Here's what arthritis research uk says about Amitriptyline:

"Amitriptyline belongs to a group of drugs called tricyclic antidepressants. Although they’re still used to treat anxiety and depression, they’re also now widely used at lower doses to help block the chronic (long-term) pain of some rheumatic conditions.

The main aim of lower-dose amitriptyline is to relieve pain, relax muscles and improve sleep, but it may also help reduce any anxiety or depression resulting from the pain."

What they don't mention is that the liklihood of a nerve being irritated when you have OA is high. The sciatic nerve and the nerves that connect to it can all be irritated by tight soft tissue - something that WILL occur in people with joint dysfunction. With a stiff hip you'll limp. That will put pressure on the sacrum causing tight muscles. Piriformis syndrom is a common cause of nerve pain resulting from this kind of thing but all of the muscles around the hip can tighten to the point where they irritate a nerve. Once irritated a nerve tends to stay that way if you don't do something about it. Amitriptyline is an excellent medication for settling down irritated nerves. Higher doeses than 20mg will probably be required to treat nerve pain. You need to slowly titre up from 10mg until either the pain subsides; until you have side-effects you can't tollerate or until you get to the maximum of 70mg.

Eventually I asked the doctor for Amitriptyline and used the guidelines in an article to titre up to the required amount. The doctor wasn't happy about this so I lied and said I was doing it under the guidance of a GP friend. I don't have any faith in my doctors. It's a teaching practice and you just get one kid after another that thinks they know it all when they know very little. I'm not advising you to lie to your doctor. In fact you shouldn't - drugs can interact badly and if you have underlying conditions the doctor needs to be the one to decide if it's safe. But had I not lied I'd probably still be in pain. The doc was happy to give me toxic, addictive pain killers but not the clearly recognised required dose of relatively safe amitryptiline.

The article in question (from a very reputable source) said it was fine to go up to 70mg a day. After 50mg there should be a doctor checking on your heart. I got to 50mg before it started to work. The article did say that in many cases the treatment fails because people don't take a high enough dose. I had zero side-effects at 50mg and the night pain was eliminated. After a couple of months I was able to reduce back down to 30mg. Another couple of months there then I gradually came off it all together. No reoccurance of pain.

Indication that it might be nerve pain: tingling or numb sensation in outer calf; restless legs; dull, throbing ache - like toothache; could be anywhere from hip, thigh, knee, calf, foot - any one of those places or all at once. Often worse when you're not moving.

The thing is, whilst this worked for the night pain I was now getting bad pain during the day when I was active. A complete reversal on the original symptoms. This made no sense. It finally turned out that the lingering pain was in my mind and that this is really common. It FEELS 100% real pain. You're not being neurotic. But the brain starts to missinterpret the signals coming from the nerves and over-reacts. Once I understood this I was able to eliminate the remaining pain in about 5 minutes flat through a simple CBT approach known as 'anchoring'.

There's an awesome video on youtube that explains beautifully how the mind is 100% responsible for pain and how it can sometimes go wrong and produce pain for no good reason. Lookup "Pain is it all in the mind" by a professor lorimor. Well worth a watch for anyone that's ever had pain.