Efficacy and safety of antidepressants ... treatment of back pain and osteoarthritis, 2021, Ferreira et al

leokitten said:
I didn’t even know they prescribed antidepressants for these conditions... thought they used NSAIDS.
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Some patients with chronic and disabling low back pain may be treated as chronic pain patients. Same for OA.

A family member has been sent for CBT for her back issues. She has a behavioral plan for when her back goes again- including not catastrophizing, not being overly emotional, etc... i was appalled when i heard.

See, there is a number of doctors who believe that unexplained chronic pain and conditions (low back pain, OA pain, chronic unexplained muscular pain, interstitial cystitis, etc) need to be treated by giving anti-depressants. They just seem to give it like candy when they don’t know what else to do
 
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I must say, antidepressants do help me with pain. In my case, Remergil (Mirtazapin) for endometriosis pain.

From what I remember, my doctor said some antidepressants are anti inflammatory, too.

Amitriptylin e.g. is often used in neuropathic pain (e.g. Post Zoster neuralgia).

Doesnt mean of course the underlying problem is psychological but I guess the antidepressants somewhat "numb down" pain perception in the brain.

Problem with NSAIDS ist they can really affect stomach and liver, so not good for daily use.

Ironically, antidepressants never did anything for my "mood".
 
Leila said:
Problem with NSAIDS ist they can really affect stomach and liver, so not good for daily use.
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I have to take lansoprazole (a PPI) with my NSAIDs because of the stomach problem. But I find my NSAIDs do help my pain a lot and I take them every day, and they don't have any affects on my brain function. Amitriptyline and nortriptyline both give me tachycardia. I was prescribed four different anti-depressants over many years during the 90s and the first decade of the 2000s, but they never achieved anything, either in reducing pain or reducing depression. I never liked the fact that anti-depressants caused me severe emotional numbing. I often felt like a walking lump of meat with no real emotions.

I was under the impression that mirtazapine causes severe withdrawal problems that can persist for years, so I wouldn't be happy to take them.
 
Leila said:
I guess one has to choose a poison here.

Unfortunately, my neuropathic pain was never much impressed by anything other than antidepressants and Pregabalin :(
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I think one of the major problems that women have is that doctors prescribe anti-depressants and sedatives to women and actual pain killers to men. If anti-depressants work that's great, but they never worked for me.

I'm surprised that you describe the pain from endometriosis as neuropathic. Personally, I don't think the pain from dense adhesions, scarring, and restricted blood supply to tissues and organs is neuropathic.
 
Arnie Pye said:
NSAIDs are actual pain killers. Doctors will very rarely prescribe actual pain killers. The medical attitude to pain has turned them all into torturers.

For proof, I offer this :

https://www.pslhub.org/forums/topic/68-painful-hysteroscopy/

https://www.hysteroscopyaction.org.uk/wp-content/uploads/2018/10/sept-2018.pdf
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Barbaric.

I've had a couple of hysteroscopies and samples taken. Each done privately with a gynae who was really good.

Each done as a day patient with a general anaesthetic.

There was talk of possible needing to do another & he was considering doing the procedure as an outpatient. He looked at my notes again and decided against partly as I've not given birth and also weighing up the options as to what will exacerbate my ME more.

Warning - maybe be TMI gynae details -
Coincidentally, regarding pain. During the first hysteroscopy they also removed excess endometrial lining. So basically, it's like having a massive period. Naturally, there is some pain, cramping and discomfort.

The anaesthetist popped in to check on me a couple of hours later and asked if I was in pain. I said I was a bit - like a bad period. She knew I had tramadol on prescription and offered to get me some. She seemed very surprised when I told her it wasn't that bad and a couple of paracetamol would probably do the trick.

I think after the pre op maybe she thought with all the details of what to avoid and so on plus the ME diagnosis she thought I was going to be very sensitive to pain? So much for central pain sensitivity theory!
 
Leila said:
I guess one has to choose a poison here.

Unfortunately, my neuropathic pain was never much impressed by anything other than antidepressants and Pregabalin :(
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I have family members who have all suffer from the same condition that can be excruciatingly painful.

Paracetamol and NSAIDs can only do so much and even on a maximum dose prescribed for them it's not enough and they can be brutally hard on the stomach.

Amitriptyline & other antidepressants have been used to help manage the pain. I think the dosage is different than when used primarily for depression though.

Horses for courses. In constant pain I'd certainly prioritize what works best, then consider what's less toxic and therefore less likely to cause other problems before worrying too much about what the drug is.
 
Arnie Pye said:
I think one of the major problems that women have is that doctors prescribe anti-depressants and sedatives to women and actual pain killers to men. If anti-depressants work that's great, but they never worked for me.
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My brother was prescribed them for pain for a while.

I agree women are probably more likely to be prescribed them though.

As they seem to be an option for pain relief then this could be as much discrimination against men as against women? It could also be that men are less likely to discuss their health problems as openly?

The same brother won't be open with his wife about how he feels physically i.e. How bad the pain is, where it is etc. He will with me but I'm very careful not to nag him or try to push him in any direction. I'll raise options in a general way - so ask if his consultant ever mentioned xxxxx as I believe that's an option when yyyyy isn't working any more rather than haven't you tried or asked about....
 
Arnie Pye said:
I think one of the major problems that women have is that doctors prescribe anti-depressants and sedatives to women and actual pain killers to men. If anti-depressants work that's great, but they never worked for me.

I'm surprised that you describe the pain from endometriosis as neuropathic. Personally, I don't think the pain from dense adhesions, scarring, and restricted blood supply to tissues and organs is neuropathic.
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It's a pain of hot, burning quality down my left leg, surgeon said it's most likely growing into a nerve there.

They couldnt remove it all (and looking back I'm glad they didn't try, who knows what they would have damaged).
 
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