Comments on: Medications For Pain Series: Antidepressants http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/ Sat, 13 Mar 2010 01:00:40 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: How to Cope with Pain http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/comment-page-1/#comment-6489 How to Cope with Pain Fri, 29 Aug 2008 11:45:26 +0000 http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/#comment-6489 Sara, thanks for your insightful comments. 2 important points you raise are 1) it's often multiple medications all used together that offer the best result. And 2) finding a doctor who really understands pain management is so important. Sara, thanks for your insightful comments. 2 important points you raise are 1) it’s often multiple medications all used together that offer the best result. And 2) finding a doctor who really understands pain management is so important.

]]> By: Sara http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/comment-page-1/#comment-6483 Sara Fri, 29 Aug 2008 03:00:50 +0000 http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/#comment-6483 My concern is that a pain disorder that can be treated with anti-depressants seems to bias doctors against offering other forms of medication management, particularly analegics. The thought that seems to be going on is this: If a patient doesn't need something to control degeneration or inflammation, then it's not a "real" disease or "as painful" of a disease and therefore "doesn't need" or it "isn't appropriate" to give the patient pain medications, particularly opiates, if the patient doesn't respond to anti-depressant therapy. I know in my experience, and in the experience of others who I have talked to, we have been told we have "severe" cases of fibromyalgia or "the worst cases of fibromyalgia" simply because TCA's and SNRI's didn't restore functioning to a managable level. I also know when my doctors thought RA was an issue they had no problem prescribing me pain medication but as soon as RA was ruled out and fibro was definitively diagnosed they gave me a hassle about it each and every visit until I finally switched to another doctor. The thing is too, even if we the patient don't have a problem with A-D's being used for pain, it does seem that there is a doctor-related bias once you are on an A-D; that you must have depression or anxiety, especially with disorders like fibro, CFIDS, CMP, or others that don't have clinical pathology to fall back on. My concern is that a pain disorder that can be treated with anti-depressants seems to bias doctors against offering other forms of medication management, particularly analegics.
The thought that seems to be going on is this: If a patient doesn’t need something to control degeneration or inflammation, then it’s not a “real” disease or “as painful” of a disease and therefore “doesn’t need” or it “isn’t appropriate” to give the patient pain medications, particularly opiates, if the patient doesn’t respond to anti-depressant therapy.
I know in my experience, and in the experience of others who I have talked to, we have been told we have “severe” cases of fibromyalgia or “the worst cases of fibromyalgia” simply because TCA’s and SNRI’s didn’t restore functioning to a managable level. I also know when my doctors thought RA was an issue they had no problem prescribing me pain medication but as soon as RA was ruled out and fibro was definitively diagnosed they gave me a hassle about it each and every visit until I finally switched to another doctor.
The thing is too, even if we the patient don’t have a problem with A-D’s being used for pain, it does seem that there is a doctor-related bias once you are on an A-D; that you must have depression or anxiety, especially with disorders like fibro, CFIDS, CMP, or others that don’t have clinical pathology to fall back on.

]]> By: How to Cope with Pain http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/comment-page-1/#comment-6251 How to Cope with Pain Thu, 07 Aug 2008 17:16:05 +0000 http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/#comment-6251 Jeff, thanks for your question. I'd recommend asking directly. Some of the TCA's can have heart side effects, but they are used at low doses for pain and these side effects can be carefully monitored. Some of the newer antidepressants for pain do not have this side effect, so might be an option. Starting the conversation with "Can we take a look at all my options for pain management, and decide what might be best to try first?" can get the ball rolling. Some doctors are prickly when a patient requests what exact medication they want ("Start me on Demerol!"), so a more general opening might be better. But keep working on this! Almost always benefits can be balanced with side effects, and there are many medication options to try. Jeff, thanks for your question. I’d recommend asking directly. Some of the TCA’s can have heart side effects, but they are used at low doses for pain and these side effects can be carefully monitored. Some of the newer antidepressants for pain do not have this side effect, so might be an option.

Starting the conversation with “Can we take a look at all my options for pain management, and decide what might be best to try first?” can get the ball rolling. Some doctors are prickly when a patient requests what exact medication they want (“Start me on Demerol!”), so a more general opening might be better. But keep working on this! Almost always benefits can be balanced with side effects, and there are many medication options to try.

]]> By: Jeff J (USA Retired) http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/comment-page-1/#comment-6250 Jeff J (USA Retired) Thu, 07 Aug 2008 16:07:36 +0000 http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/#comment-6250 My 84 year-old father is suffering from a great deal of back pain from a WWII injury; as well as blood passing with his urine and stool that was caused by radiation treatment to fight prostrate cancer. He and his doctor are reluctant to use pain medications because the side effects may lead to heart problems. He also takes a blood thinner due to a stroke he suffered 40 years ago. How do I coach him to speak with his doctor about using an antidepressant therapy? My 84 year-old father is suffering from a great deal of back pain from a WWII injury; as well as blood passing with his urine and stool that was caused by radiation treatment to fight prostrate cancer. He and his doctor are reluctant to use pain medications because the side effects may lead to heart problems. He also takes a blood thinner due to a stroke he suffered 40 years ago.

How do I coach him to speak with his doctor about using an antidepressant therapy?

]]> By: How to Cope with Pain http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/comment-page-1/#comment-4519 How to Cope with Pain Sat, 17 Nov 2007 11:48:55 +0000 http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/#comment-4519 Heidi, thanks for these points. I review with patients that antidepressants work in chronic pain <i>even if</i> you're not depressed. Pain and depression are 2 different things, with regards to what antidepressants treat. I do ask patients to sometimes tolerate <i>some</i> side effects, as with many of these drugs, there is a trade off unfortunately. But only you can decide if the trade off is worth it, and your physician should respect that. Keep talking to your doc! Heidi, thanks for these points. I review with patients that antidepressants work in chronic pain even if you’re not depressed. Pain and depression are 2 different things, with regards to what antidepressants treat.

I do ask patients to sometimes tolerate some side effects, as with many of these drugs, there is a trade off unfortunately. But only you can decide if the trade off is worth it, and your physician should respect that. Keep talking to your doc!

]]> By: Heidi http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/comment-page-1/#comment-4511 Heidi Sat, 17 Nov 2007 04:37:56 +0000 http://www.howtocopewithpain.org/blog/146/medications-for-pain-series-antidepressants/#comment-4511 I've seen a couple of problems with antidepressants as pain treatment. The first is simple: many doctors, looking at a meds list that includes antidepressants, stop looking right there. All pain, fatigue, headache, and related symptoms are simply part of depression then, and they look no further. The second issue I've seen is that doctors often don't realize how many drugs work in the same systems. Migraine? Bring on the triptans! It's debatable which is worse, the migraine, or the feeling your head is going to explode from the overdose of serotonin and resultant high blood pressure. Same problem with tramadol. Of course, once a patient says they can't use those 'non-narcotic' offerings, they're labeled as drug-seeking. It's enough to make a person give up and sit at home in pain. I’ve seen a couple of problems with antidepressants as pain treatment.

The first is simple: many doctors, looking at a meds list that includes antidepressants, stop looking right there. All pain, fatigue, headache, and related symptoms are simply part of depression then, and they look no further.

The second issue I’ve seen is that doctors often don’t realize how many drugs work in the same systems. Migraine? Bring on the triptans! It’s debatable which is worse, the migraine, or the feeling your head is going to explode from the overdose of serotonin and resultant high blood pressure. Same problem with tramadol.

Of course, once a patient says they can’t use those ‘non-narcotic’ offerings, they’re labeled as drug-seeking.

It’s enough to make a person give up and sit at home in pain.

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