Tricyclic Antidepressants

Anti-depressants for severe pain?

Question:

Does anyone have any experience using nefazadone or other anti-depressants for severe neck or back pain? I have been trying to get the pain specialist at the VA to prescribe something stronger, but he seems determined to try me on every anti-depressant going before he will treat my pain agressively. He also made it clear that i would have to see the anesthesiologist for possible epidural shots before he would prescribe serious pain medication. That will take more than two months from now! I have tried the various tri-cyclics before, and they were useless even when the pain was milder than it is now. I have spinal stenosis in the cervical spine and lower back, and I am in constant excruciating pain. I am starting to go off the deep end, and I would prefer something that acts faster for this type of pain. I am unable to communicate the seriousness or immediacy of the situation to this "specialist," and I have no idea if I will even get pain relief after I’ve gone though all the bullshit. So I’m playing an extremely demoralizing waiting game. If anyone has any personal experiences with these medications or overcoming doctor bullshit, please let me know. Sean C

Response:

Sean, I’ve been on Prozac for 10 years and it never *touched* my back pain (spondylolisthesis, etc.).  I just went to my first real "pain doctor" a month ago.  I had to fill out an 8 page form beforehand and bring it with me.  On this form, I made it (nicely but firmly) clear that I did NOT want any invasive procedures done (epidural injections, etc.).  He gave me enough Norco (no problem) to last me a month, which is when I return to him.  Stand your ground.  ***Get pain medication.*** Have you seen Skip Baker’s website yet?  I’m not sure if this is his homepage, but it’ll sure give you a BIG start: http://www.asappain.com/2ThePatient.html Keep posting further questions here.  These folks have been a *big* help to me. Best, Editor

– Hide quoted text — Show quoted text -> Does anyone have any experience using nefazadone or other > anti-depressants for severe neck or back pain? I have been trying to > get the pain specialist at the VA to prescribe something stronger, but > he seems determined to try me on every anti-depressant going before he > will treat my pain agressively. He also made it clear that i would have > to see the anesthesiologist for possible epidural shots before he would > prescribe serious pain medication. That will take more than two months > from now! I have tried the various tri-cyclics before, and they were > useless even when the pain was milder than it is now. I have spinal > stenosis in the cervical spine and lower back, and I am in constant > excruciating pain. I am starting to go off the deep end, and I would > prefer something that acts faster for this type of pain. > I am unable to communicate the seriousness or immediacy of the > situation to this "specialist," and I have no idea if I will even get > pain relief after I’ve gone though all the bullshit. So I’m playing an > extremely demoralizing waiting game. > If anyone has any personal experiences with these medications or > overcoming doctor bullshit, please let me know. > Sean C

Response:

I was already on Paxil ( had been put on about 6months b4 the wreck — in 1995) and in 2000, when I found a doc (b4 I realized he was tagged By the DEA) he put me on Effexor and Wellbutrin….the W for depression/pain and to help me quit smoking.  Didn’t help the smoking, but it MIGHT have helped some in the depression dept. and the pain.  The concept makes sense….Pain and the situation that put you there is DEPRESSING.  If they can lift a patient out of the funk, then that person has a bit more strength ….An "up" patient may be able to ignore/deal w/ the pain,   Am I upper?  Well, I HAD considered blowing my brains out about 100 times a day……now maybe only 50 times a week.  ;) Hope that helped…a little input….. Rae

– Hide quoted text — Show quoted text -> Does anyone have any experience using nefazadone or other > anti-depressants for severe neck or back pain? I have been trying to > get the pain specialist at the VA to prescribe something stronger, but > he seems determined to try me on every anti-depressant going before he > will treat my pain agressively. He also made it clear that i would have > to see the anesthesiologist for possible epidural shots before he would > prescribe serious pain medication. That will take more than two months > from now! I have tried the various tri-cyclics before, and they were > useless even when the pain was milder than it is now. I have spinal > stenosis in the cervical spine and lower back, and I am in constant > excruciating pain. I am starting to go off the deep end, and I would > prefer something that acts faster for this type of pain. > I am unable to communicate the seriousness or immediacy of the > situation to this "specialist," and I have no idea if I will even get > pain relief after I’ve gone though all the bullshit. So I’m playing an > extremely demoralizing waiting game. > If anyone has any personal experiences with these medications or > overcoming doctor bullshit, please let me know. > Sean C

Response:

> Does anyone have any experience using nefazadone or other > anti-depressants for severe neck or back pain?

They don’t know how or why, but some people respond to low doses of tricyclic antidepressants (and maybe some others now, they come out with a new one about every other week). I don’t think they do diddly-squat for severe pain.  They sure didn’t for me. Jon Miller

Response:

Sean: >Does anyone have any experience using nefazadone or other >anti-depressants for severe neck or back pain?

I’ve never used nefazadone, but have used other kinds of anti-depressants for other kinds of chronic pain.  Some doctors prescribe them because they think you’re just depressed and not really in pain…other doctors think chronic pain makes nerves hypersensitive to pain, which can be changed by adjusting neurotransmitters.  And anti-depressants work by adjusting neurotransmitters. It sometimes seems to work this way, with some kinds of headaches or chronic pain involving nerve damage.   There don’t seem to be very many people who find that anti-depressants alone relieve severe chronic pain. More often, the anti-depressants are helpful in combination with other kinds of medication (pain relievers, anti- inflammatories, some kinds of drugs which work directly on the nerves.)  Some types and doses of anti-depressants help some patients sleep more soundly, and of course it’s easier to cope with chronic pain when you’re well rested. >I have been trying to >get the pain specialist at the VA to prescribe something stronger, but >he seems determined to try me on every anti-depressant going before he >will treat my pain agressively.

A pain specialist who will not treat you with ANYTHING but anti-depressants?  Either he is completely incompetent, or he doesn’t believe anything is wrong with you except depression.  Are you having problems with depression as well as chronic pain?  Lots of people have both. >He also made it clear that i would have >to see the anesthesiologist for possible epidural shots before he would >prescribe serious pain medication.

It’s reasonable for you to talk to an anesthesiologist, but epidural shots might not be a good idea.  They are less invasive than surgery, but they can be risky.  It’s not right for a doctor to coerce you into taking that kind of risk.  Some people on this newsgroup have had very bad experiences with epidural shots, and they explain what can go wrong. I understand that working through the VA limits your choice of doctors, but please try to find better pain treatment.   Just because someone calls himself a pain specialist doesn’t always mean he knows what he is doing.  I sympathize with your frustration.   Adrian Turtle Opportunity knocks once.  Temptation leans on the doorbell.

Response:

Hi Adrian, thanks for your response. > A pain specialist who will not treat you with ANYTHING > but anti-depressants?  Either he is completely incompetent, > or he doesn’t believe anything is wrong with you except > depression.  Are you having problems with depression as > well as chronic pain?  Lots of people have both.

I believe he *might* treat me with something stonger–in fact, he had mentioned the possibility I might need methadone and then did an about-face the next visit. I believe there is an issue here of suspected drug abuse, since I made the mistake of asking for opiate pain medications directly from my VA primary care doc–who thinks tylenol is sufficient to treat my pain–and further compunded my error with the pain specialist by asking him what i should do if the anti-convulsant Topirimate he prescribed should fail to work–as if I planned for it to do so. I have only used opiods on a limited basis, a grand total of about 60 pills, with the strongest dose being 2 Percocet 5, which proved essentially useless. I’m hardly an addict.  I was also referred to the staff psychiatrist, who insisted on discussing my childhood and other irrelevant nonsense and pointedly refused to discuss my pain or its impact on my life. Essentially, I got a knee-jerk diagnosis of depression from her, despite the fact that I *know* I am not clinically depressed. I know this because on the rare occasions my pain drops down to a 4 or 5, I feel perfectly fine mentally. – Hide quoted text — Show quoted text ->He also made it clear that i would have >to see the anesthesiologist for possible epidural shots before he would >prescribe serious pain medication. > It’s reasonable for you to talk to an anesthesiologist, > but epidural shots might not be a good idea.  They are > less invasive than surgery, but they can be risky.  It’s > not right for a doctor to coerce you into taking that > kind of risk.  Some people on this newsgroup have had > very bad experiences with epidural shots, and they > explain what can go wrong. > I understand that working through the VA limits your choice > of doctors, but please try to find better pain treatment.   > Just because someone calls himself a pain specialist doesn’t > always mean he knows what he is doing.  I sympathize with > your frustration.  

Thanks again. Sean C

Response:

Sorry about pain, but for a small number of people anti-depress do seem to work.  If you are not satisfied with the quality of care you are receiving, make a trip to the patient advocate.  Explain what you are feeling and the treatment is not working.  The VA I go to has a marvelous pain clinic. george

Response:

I disagree.   It makes more sense to treat the pain which is causing the depression first.  It makes little sense to treat depression caused by pain when the pain itself is not being adequatly treated. People should not have to put up with or deal with pain when that pain could be treated with opioid  pain medications. Doctors who use anti-depressants rather than opiate or opioid pain medications to treat pain are often "opiophobic".  While some anti-depressants actualy may have some use in treating some types of nerve pain, physicians often prescribe or suggest this medication in order to avoid treating pain with narcotic pain medications. >Pain

and the situation that put you there is DEPRESSING.  If they can lift a patient out of the funk, then that person has a bit more strength ….An "up" patient may be able to ignore/deal w/ the pain, <

Response:

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