I’ve been taking low dose amitriptyline for over a month now for chronic pain and migraine relief.
Briefly I have had (so far) success with it. I’m doing a blog post about my experience in the hope it may help others considering trying it.
For me a 20mg dose taken at night has offered excellent day to day relief from migraines, pre-migraine head (feeling light headed and sickly) and for chronic pain like stiffness in my neck and shoulders.
I find with my ME/CFS/CFIDS the low dose is not quite enough to prevent pain and migraine when I do more than usual. If I overdo it even slightly the pain quickly tips past my blanked out point. But I find it beneficial all the same and day to day have been using just a fraction of over the counter pain killers and prescribed migraine medication.
I take the amitriptyline at night to avoid the worst of the sedative type effect. If I have to get up in the night to use the toilet I feel a bit like I am walking through treacle.
I started on a 10mg dose (I think this is the lowest dose you can take). The relief was just as effective for me as with 20mg but I found it started to wear off around 6-7 hours before the next dose was due (late afternoon and evening for me). 20mg has proven to me the optimum dose for me personally.
I did take my nightly dose up to 30mg under my doctors direction but found the side effects too bad to handle. I suffered with drowsiness during the day time, constantly feeling like I was ready to sleep. I also had many headaches and a terrible stiffness in my neck which felt very solid and even worse than the pain I have with no medication at all! Also I suffered with a constant dry mouth and throat, a sensation not soothed by drinking water or anything else. The inside of my mouth and back of my throat started to feel like rubber after a week. I drank lots of fluids (being constantly thirsty) but it didn’t help and just made me need many trips to the toilet!
Now I’m back down to 20mg those effects have gone. I still feel a little drowsy in the earlier part of the morning but it does not interfere badly with my usual routine. I also still have a dry mouth but this is only usually very bad 30-60 minutes after taking the tablets. I also get terrible dry eyes but this is only overnight and does not persist the next day.
The pain relief lasts the whole of the next day up until a couple of hours before my next dose is due.
Everyone is different and people with ME/CFS/CFIDS can be very sensitive to medications. I have yet to review my findings with my doctor – who knows she may want me to try a bigger dose for longer to see if the side effects persist!
I was highly sceptical about taking a tri-cylic or any kind of anti-depressant for pain relief and was worried it would send out the wrong signals about my condition. The dosage is too low to have an anti-depressant effect and if people are misinformed I guess it’s up to me to put them straight :-)
Although it is still early days on this medication, personally I have found amitriptyline to be a useful and effective preventative treatment for chronic migraines and pre-migraine feelings, as well as for low level chronic pain.
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UPDATE: 12 August 2010
I’ve been taking amitriptyline for pain relief for over 3 years now. It is still effective in controlling my day to day pain. I take my tablets around 7.30pm and taking them earlier has meant I’ve lost that lasting groggy feeling when I wake.
Ten months ago I upped my dosage (with my GP) to 30mg and that is still my current dosage. I did experience (as before) some initial increase in pain levels when I upped the dose which lasted a few weeks. I was also a lot more tired in the mornings which may or may not have been related. It’s very hard to tell with ME/CFS.
It’s difficult to measure if that increase in pain has persisted or not. Generally speaking I am still not taking as many pain killers or migraine tablets as I was before I had low dose tricyclics.
The side effects of a dry mouth continues to persist but I’m glad to report that I don’t seem to have had any more dental problems than has been typical for me (a sweet tooth I’m afraid). The thirst and dry mouth bugs me – but the pain relief is worth it.
I do still get pain and migraines. It’s not totally gone for me. But day to day the pain is much better. Also I realise now that my chronic back pain (compacted disc in my lower spine and sciatica) is pretty much gone unless I do silly things to aggreviate the problem. The pain relief of course masks the pain so I’m still beating up my spine and pinching my nerves but most days I don’t feel it at all. This is a great bonus for me.
I’m really pleased and proud that so many people have found this blog post useful especially those who’ve felt apprehensive about trying amitriptyline for pain and/or migraine relief.