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Amitriptylin (Elavil) Anyone? Amitriptylin (Elavil) Anyone?

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Unread 04-02-2003, 06:52 AM
Amitriptylin (Elavil) Anyone?

Hi, it's me the runner again. I posted a couple of weeks ago telling my story. Well, now it continues.

I went to U of M on Monday and the dr. prescribed Elavil for my pain. I'm the type of person who hates to even take an Advil, let alone an anti-depressant! I did some research on it and I do see that it is used to treat chronic pain.

Just wondered about your experiences with this medication and whether you think that I should just get yet another opinion. This dr. pretty much said that I either try this or live with the way that I feel. I was told to start on 10 mg per day and every 5-7 days increase by 10 mg. I am to call the nurse practitioner on Apr. 25th to let her know if it's helping. If not, she want to schedule me for a morning of PT and afternoon with the dr. probably early in May. (I've already been to PT which didn't help). This is the dr. who examined me back in Dec. and said I have myofacial syndrome and sent me to PT. I asked why he thinks it is chronic pain rather than something that may have gone wrong with my two surgeries (remember I don't trust the drs. who did the surgeries) and he said that he could tell from his exam in Dec. that it's neurological.

Would LOVE your opinions once again!
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Unread 04-02-2003, 07:52 AM
Amitriptylin (Elavil) Anyone?


I was diagnosed with MPS/FMS last summer and have been taking Elavil for quite some time. First it was 50 mg @ bedtime and later was increased to 100 mg. I must say that it has helped the pain and improved my sleep patterns a great deal. However, I have packed on the pounds and believe the Elavil has played a part in that gain. Bottom line -- if you aren't comfortable with your doc's opinion seek another. Good luck and keep us posted on how it goes.
Unread 04-02-2003, 09:38 AM

Well, I could use to put on some weight but I'd prefer to do it by eating, not by taking medication. Did you have problems with feeling groggy? I took my first pill last night and I'm still feeling groggy! I don't do well with medications, anyway, I think because I am kind of tiny and they really wipe me out. After my TVH and second surgery, I only took Motrin as anything stronger just made me feel awful. Have you tried any other medications that might not make me so drowsy? Thanks again!
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Unread 04-02-2003, 10:20 AM
Amitriptylin (Elavil) Anyone?

It has been so long since I started it that I don't remember if it made me groggy or not. It certainly doesn't now so, maybe just something your body would adjust to in time? How many mg did you take? I do remember becoming jittery mid-afternoon when I took the 50 mg -- that was the reason for upping it. I was told that Elavil works on the pain sensors in the brain which is why it is used for chronic pain. It really has worked better than anything for me all things considered. You might talk to your doc about the groggy feeling and see if there is something similar that might not have that affect on you? Or discuss a smaller dosage?

I also take Ultram (pain pill) and Soma (muscle relaxer) for breakthrough pain. The Soma would definitely make you groggy if the Elavil did though. On that too, there might be another muscle relaxer that wouldn't?

I still say, give your doc a call. That's what you pay him for!
Unread 04-03-2003, 03:58 PM
Amitriptylin (Elavil) Anyone?

I also take Elavil 100 mgs at night, I have been on this med for years to treat my pain. It does take some time to adjust to the side effects but they do go away as your body adjusts I am 5'6" & weigh 119 lbs, it hasnt caused me any weight gain. We are all different tho...I was dx'd with FMS a few yrs ago, I also have MPS. Like Vbjack I take Soma with good results! Pls call your Dr maybe there is something else he can try?? Here is some info on this syndrome that might be of some help:

A number of medications have been used to improve sleep in fibromyalgia. The oldest of these is amitriptyline (Elavil), a medication first used to treat depression. Amitriptyline and related medications probably work by improving the quality and depth of deep sleep rather than by any effect on mood. Although it probably works as well as any of the other medications, amitriptyline causes frequent bothersome side effects such as weight gain, dry mouth, daytime tiredness, and trouble concentrating more often than other medications with durations of action more appropriate for sleep so I usually try these other medications first. They include trazodone (Desyrel), diphenhydramine (Benadryl), cyclobenzaprine (Flexeril), alprazolam (Xanax), and carisoprodol (Soma).

In the US, all chronic pain conditions are seriously undermedicated. Chronic pain conditions like FMS, certain kinds of low back pain, and migraines, where there are not hard physical findings such as abnormal X-rays, tend to be the most undertreated. But the problem is not linited to these conditions. A recent study found that 1/3 of terminal cancer patients were not prescribed proper pain medication and therefore did not get relief. In the study of cancer pain, three reasons were given by physicians for why they had not prescribed more medication: 1) Despite the fact that these were *terminal patients in the last few months of life*, physicians were afraid of creating an addiction. 2) The doctors were afraid of harrassment by the Drug Enforcement Administration if they gave out too many narcotic prescriptions. The DEA keeps a very close eye on doctors, because a few rotten eggs have gone into the 'prescription mill' business of providing narcotics for street addicts. 3) The most common reason: physicians simply didn't ask their patients if they were in pain. They assumed that the patient would ask them if they needed help.
This study also found that physicians often didn't prescribe the medication correctly and that medications were often inappropriately withheld by nurses (this isn't a rant only against doctors. Unfortunately my own profession is also ill-informed.) This study is alarming, because terminal cancer is a condition where severe pain is expected. Imagine, therefore, what other people in pain must be facing. And in fact, other studies have found similar results, with pain relief in children being another problem area. This, then, is the atmosphere in which a patient with FMS must seek treatment. But people with FMS have additional problems. Often, we have been complaining of pain for years. Many of us who have had pain that was more severe in one area such as the lower abdomen or low back have seen many doctors and had countless tests to rule out serious problems. We may even have had unnecessary surgeries: women with FMS have frequently had laparoscopies to find endometriosis. Others of us have been told that we had carpal tunnel syndrome or disorders of spinal disks. When treatment for these conditions don't work, or when nothing is found on tests, physicians often stop believing that we have pain at all. Many times, people with FMS have been told that they are hypochondriacs or just seeking attention and told to get psychiatric help. Worse, some of us have been labelled as drug addicts and had our medical records so marked. Some of us have even been verbally abused by physicians.

don't give up! It IS possible to get fair, even good pain relief, in fibromyalagia syndrome.

First, you need a physician who knows about FMS and takes it seriously. The best way to find a doctor knowledgable about FMS is to check with your local FMS support group or ask for recommendations over on (which is also the fibromyalgia mailing list; they're gated.) If you have no idea how to find a local support group, you don't know how to find, or if you just don't know much about fibromyalgia syndrome in general, I have a very *long* FAQ I can send you by e-mail. If you request it, I can also send you an article I wrote called "Dealing With Doctors When You Have Chronic Fatigue Syndrome". Even though the article is about CFS, the information is very applicable to folks with fibromyalgia syndrome. In it, I talk about how to get physicians to take your condition seriously, how to get your medical records, how to search medical databases, books you should buy and many other things. Often, rheumatologists are the doctors who take care of people with FMS and generally they are pretty well informed. You may also want to consult a physician who specialzes in pain management if you haven't already. Most people with FMS seem to do best with a combination of therapies, which may mean combining non-drug treatments with medications, or combining several different kinds of medications or both. Pain specialists have access to not only many drugs but also to many non drug therapies as well. If you can find one who is knowledgable about FMS, pain specialists can be quite helpful in developing a multi-factor treatment. Usually you need a referral from another physician to see a pain management specialist.

Pain medication options include: Muscle relaxants: This is often another way of saying 'benzodiazepine' (see sleep med section above.) However benzos can be helpful in dealing with muscle spasms. There is also an anti-depressant called Flexeril that many people with FMS find helpful because it has genuine muscle relaxant effects. This catagory also includes carisoprodol (Soma, Rela) which basically metabolizes to a tranquillizer called meprobamate. Meprobamate is addictive; however carisoprodol does have muscle relaxant effects via the central nervous system and so may be helpful to some people with FMS.
Ultram (tramadol): Some people with FMS swear by it. It has the advantage of not producing the buzz associated with opiates and benzodiazepines. This can be a big plus with people who have brain fog. Ultram was originally promoted as a non-addicting alternative to opiates. However, a number of cases of addiction have now been reported in the literature, so this is no longer considered true, although it may prove less addictive than opiates: the jury is out on that. Tolerance appears to develop pretty quickly and people *definitely* go through withdrawal when they get off it. It also causes nausea in a significant percentage of people. Myself, I found that even taking 100 mg. of Ultram three times a day didn't help my FMS pain nearly as well as 1 Tylenol #3 at night, although I also didn't have the nausea often associated with it.
I see a great many patients who have sustained soft tissue injuries in automobile or slip and fall accidents. Many of them, perhaps 30%, claim that tylenol, advil, Tylenol 3, or Darvocet have been of no help. I am then faced with deciding whether to give them hydrocodone and for how long and in what dosage. I taper the dosage from three 7.5/day down to two 5mgm/day over a three to five month period, and usually during the last two months, I can get them to take an anti-inflammatory medication. I know that some of the patients abuse the drugs, but I feel that to withold medication from the larger number would not be proper. It is frustrating and maddening, wondering who's lying or not, on a daily basis. I wound up fighting for ten minutes with someone about four Soma's a day versus three a day, and suddenly felt that it was an absurd fight. Stewart E. Altman, MD

TREATMENTS (Medication and Other Treatments) Medications Medications effective in the treatment of FMS appear to work mainly through an effect on deep sleep (Goldenberg 1986). They should be started at the lowest possible dose and increased every few days to a week to maximum relief of daytime FMS symptoms without unacceptable side effects. I allow patients to fine-tune the dose themselves. The starting doses and ranges of several medications useful in the treatment of FMS are listed in Table 1 in roughly the order I tend to try them. Amitriptyline is an effective medication for FMS but it has frequent daytime side effects attributable to its long half life such as weight gain, dry mouth, and cognitive impairment, so I usually start with the shorter-acting medications. It is often necessary to try several different medications in succession and sometimes in combination before finding a regimen that works well. Tolerance often develops to the sedative effect of many of these, necessitating one or two dose increases after an initial good response to maintain efficacy. When switching from one medication to another, I recommend adding the second while continuing the first to try to maintain sleep quality and avoid exacerbating FMS symptoms unless problems with the first medication preclude this approach. Once improvement is noted or if side effects on the combination develop, the patient is instructed to begin tapering the first medication slowly. If it is necessary to taper the first medication while increasing the second, dose changes should not be made in both medications at the same time. Leaving a few days between an increase in the dose of one medication and a decrease in the dose of another makes it possible to tell whether it is the withdrawal of the first medication or the addition of the second that is causing any problems that develop. Imipramine, steroids, and non-steroidal anti-inflammatory drugs (NSAIDs) have all been found to be no better than placebo for FMS (Goldenberg 1993). While NSAIDs might be expected to be helpful if only for the analgesic effect, their tendency to cause some insomnia may cancel out the expected benefit. Narcotics and benzodiazepines other than alprazolam block stage 4 sleep and so should be avoided. While they may help symptomatically, they often make the patient feel worse the next day and may prevent her from ever being able to get to the point of being pain-free most of the time. Tramadol and acetaminophen do not seem to interfere with sleep and are therefore a better choice for analgesia. Fluoxetine was found in one study to be ineffective except to symptomatically treat associated depression (Wolfe, 1994). A second study found it effective, especially in combination with amitriptyline (Goldenberg 1996), but this may have been because fluoxetine increases amitriptyline levels which weren't monitored. A second serotonin re-uptake inhibitor, citalopram, was ineffective for FMS symptoms (Nxrregaard 1995). There are many other unstudied "alternative" drug and herbal treatments, some of which may in the future be proven effective in controlled studies. I do not recommend these since they are as yet unproven scientifically and may have unrecognized toxicities, but I have given up trying to dissuade patients from trying them as long as it is not in place of conventional therapy.

Fibromyalgia and Chronic Myofascial Pain Syndrome:

Dealing With Chronic Pain:

Fibromyalgia: Finding Treatments That Work for You:

Good Luck with finding some relief Pls keep us posted...((hugs))
Unread 04-03-2003, 06:11 PM
Amitriptylin (Elavil) Anyone?

There are many many different meds that the doctor can try if he thinks your pain is neurological. We are all different and while one med may help someone you may need something else.

With many of the neurological meds there can be side effects that will dissipate with time. I've taken Neurontin several times and the first two times I had awful side effects that I just couldn't tolerate and than the third time I tried it I didn't have any side effects at all. Unfortunately it didn't do much for my pain either.

I did try Elavil once and didn't do well on it. It made me very cranky and moody. But that was me and as you can see here it is helpful for some.

If any symptoms you experience are bearable, it may be worthwhile to give the med a chance.
Unread 04-04-2003, 07:14 AM
Amitriptylin (Elavil) Anyone?

I only took 10 mg. The first one I took on Tues. about 11pm and I was so tired I stayed home from work on Wed. I slept almost all day and all night. I took another 10 mg at about 10pm on Wed. and forced myself to go to work on Thurs. I couldn't concentrate and went right home and went to sleep. My husband woke me up to go to bed last night and we both said let's throw these pills in the trash! I'm really at a loss now as to what to do. Any suggestions are welcome! I did try to get ahold of the nurse pract. and she's out until next Wed. I will call her then. I don't want to call the dr. because he basically said that I either take the med. or don't get better.
Unread 04-04-2003, 09:10 AM
Amitriptylin (Elavil) Anyone?

I'm sorry that your doctor is not being cooperative. Have you considered perhaps trying a Pain Clinic? Pain Mgmt doctors are usually more knowledgeable about the different options and meds to control pain. As I said earlier what works for one may not work for someone else.

My doctor had me try Elavil, Neurontin and a few other things. When those failed to control my pain he referred me to a Pain Mgmt Clinic.

I had to try a few meds there also. Currently I am using the Duragesic Patch and Darvocet N100 for breakthru. I also need to find a new pain doc as mine closed up shop and moved and he's no longer on my insurance.

There's some good information in the Resources forum here about pain clinics. Here's the link

Unread 04-04-2003, 09:19 AM

Thank you, I will check out these resources. The dr. that I am going to is supposed to be a pelvic pain specialist and famous throught the country for his robotic and non-invasive surgery. ABC has even done a segment on him. That's why I can't figure out why he is so reluctant to go in with the scope as my belief is that something went wrong with one of my two previous surgeries as they were done here in small town America. Oh well, thanks for the support. Perhaps there is a pain management clinic separate from his clinic?
Unread 04-04-2003, 09:51 AM
HI Running sister...

Sorry you are still having all the pain Chronic pain can be draining....

I tried Elavil for a period for a couple of weeks....probably not long enough to notice any pain relief. I didn't care for the way it made me feel....really zombied out and drugged up.

I know that my doctor and several sisters said you need to stay on it for awile to realize the possible benefits, but for me...2 weeks was enough.

I wish you the best...


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