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Chronic Pain

Medication: antidepressants and antiepileptics for chronic pain

Some people we talked to had been prescribed drugs which are usually used to treat either epilepsy (antiepileptics) such as gabapentin or pregabalin or depression (tricyclic antidepressants) such as amitriptyline and duloxetine. This is not because they have epilepsy or depression but because it has been discovered that these drugs can also help certain types of pain. NICE- National Institute for Health and Care Excellence (Guidelines CG173 updated April 2018) recommends that patients be offered: “a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain (except trigeminal neuralgia)".

Several people were using a tricyclic antidepressant drug for nerve type pain such as amitriptyline. People were keen to emphasise that these acted by damping down the nerve activity and were prescribed in much lower doses than would be used for depression. One man was disappointed that this had not been explained to him but had found information about it on the Internet.

 

Was disappointed that his GP did not explain that the antidepressant was to treat his nerve pain,...

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Age at interview: 38
Sex: Male
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When you were prescribed the amitriptyline, how did you feel about taking that?

I was open minded until' Again I trust the doctor, but I was still optimistic that things would get better at that time, and so to be prescribed something else, to me seemed that I was going in the wrong direction. I went to my GP and then my GP met me at me local chemist and I asked about them, and he said, 'They're antidepressants', and I says, 'Well I'm not depressed'. 

So I immediately went home, onto the internet and I looked up amitriptyline, which confirmed that they're antidepressants and it never cheered me up any. It was only later through the pain clinic website that I saw on the pain and depression page the use of amitriptyline, and I've since seen my GP and had a chat about that drug with him, make him aware that, you should have told me about the neurological, or the neuro side of things more clearly because I was quite disappointed that I'd been prescribed downers, or antidepressants, so a wee bit confusing, similarly the chemist came straight out with it, 'They're antidepressants', so I was quite disappointed, yeah.

People using an antidepressant commonly experienced a dry mouth and sleepiness. One woman found the dry mouth problematic because she often had to make presentations at work. She was concerned that reduced saliva might be affecting her teeth and had been given special toothpaste. Whilst sleepiness bothered some, others found it helpful, as their sleep had been previously disturbed.

 

Finds that she gets a dry mouth from taking amitriptyline and has to use special toothpaste to...

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Age at interview: 42
Sex: Female
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You've got, with the amitriptyline you've got dry mouth sensation and that is absolutely horrible and because I present in a, you know when I go down for meetings I'm presenting and when you're talking for half an hour to forty minutes, it's, you can almost feel your lips, you know, sort of like sticking to, and it's just horrible and I'm sure people are not aware of it but I'm aware of it and that then has an effect. 

I mean for example the mouth dryness has then affected my teeth, which again I didn't even think of but I go for my regular check-ups and basically because the, I'm not having the same secretions, I'm not having the same anti-bacterial activity in my saliva because it's basically not there, and that is starting to affect my teeth and now I have to use special toothpaste and you know it, one thing leads onto another and at the end of it you just sometimes think you're a complete and absolute wreck.

Anti-epileptic drugs such as gabapentin (Neurontin) and carbamazepine (Tegretol) were sometimes prescribed for nerve pain. One lady with multiple sclerosis was using gabapentin to treat her nerve pain. Others used it to treat nerve pain due to an injury.

 

Explains that she takes gabapentin, an antiepileptic drug which also relieves nerve pain.

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Age at interview: 32
Sex: Female
Age at diagnosis: 26
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And the most recent addition is gabapentin which... It's what's been amazing with pain management is they're now using a lot of drugs that weren't designed for pain management. Gabapentin was actually an anti-convulsant, but they found it has a really good affect on neuropathic nerve pain, which is the reason I'm on it. And I've had to increase the dose, I've had to increase it slowly, because in combination with everything else I'm on, when I first started taking it, I was just absolutely, I was not with the world for a few weeks, I was just absolutely asleep.  

But, as time's gone on, I've got used to it. I'm absolutely fine on it again now. And I've got to a level at the moment where I haven't had to increase it for a few weeks, so I'm hoping I'll be able to keep it at the level where I am for a while, with room to increase if I get worse again.  

Carbamazepine is now recommended by NICE (CG173 updated April 2018) as an initial treatment for trigeminal neuralgia rather than gabapentin which is more suitable for neuropathic pain.

One woman describes her experiences of the side effects of gabapentin which included weight gain and dry mouth. She also felt that it may be affecting her memory but wondered whether this was to do with the pain.
 

Describes the side effects that she has with Neurontin (gabapentin).

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Age at interview: 30
Sex: Female
Age at diagnosis: 26
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Do you have any side effects from the Neurontin (gabapentin)?

Weight gain is one that's attributed to it because it apparently increases your appetite and also can make you retain water. I get a very dry mouth. Some of the symptoms it's very difficult to tell because I've, it's been so long since I haven't had drugs of one sort or another, it's difficult to tell how many symptoms I have from my condition and how many are from the drugs that I take. 

Very dry mouth, I can choke very easily and part of that could be the restriction in the neck and part of that is the fact that I'm so dry from the drugs. Concentration and short-term memory, not sure again whether it's drugs or whether it's the condition. I think it's most likely to be the drugs to be honest. 

I don't see why the condition should particularly affect my memory. It's not that it's disastrous, I mean I have got short-term memory, but it takes me a long time to remember people's names. 

I double book myself in my, somewhat slim, social calendar, I still manage to double book myself and things because I can't remember that somebody's said in passing 'Lets do something on a Friday night'. I end up doing three things on one night and nothing for the rest of the month kind of thing. But people have got used to me now.  'Write it down'.  Mum bought me a notice board to put up in the kitchen so I didn't forget things quite so much.  

Last reviewed August 2018.

Last updated August 2018.

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