Thanks Chris......:)

Each drug is different. Amitriptyline is a tricyclic antidepressant and takes at least a month or more to get into the brain to work on pain. It is the only drug so far showing promise in the peripheral system to enhance growth factors and healing.

Gabapentin and lyrica work in the spinal cord to block pain signals coming in from the periphery. So they tend to work faster, but there is no sign of any effects on healing.
They also go to the brain, but seem faster having effects. Gabapentin was designed originally to help reduce seizures.

Everyone is different and everyone has a slightly different cause of PN. There are over 100 causes. So you cannot expect the exact responses someone else tells you they had.

My Dr. suggested taking the 20 mg of amitriptyline at around 6 or 7 pm. I normally go to sleep between 9 and 10pm. This way works so I am not groggy in the morning. I am taking Benfotiamine 150mg, R-ALA 100mg, and acetyl L-Carnitine 400mg, fish oil, magnesium citrate, D3 2000iu, B12.
I still do wake up from pain, but not as much as before I began taking amitriptyline and vitamins. I hope this helps you!

I brought up amitriptyline to my neuro becuase i said gabapentins side effects are less than desirable. he told me that if side effects are an issue amitriptyline is not the way to go. Said that it has more than gabapentin does. Also said the tough thing with using an anti-depressant of any kind is simply this, if you aren't depressed or dealing with a chemical imbalance it is often counterintuitive. There are many other types of tricycylic anti depressants as well. Pamelor of another that is often prescribed and supposedly is a little better tolerated.

I am sorry to say, I think your doctor doesn't know about the new research of LOW DOSE tricyclics helping with nerve repair.
The doses used for amitriptyline are far below those for depression. The depression doses are 150mg to 300mg a day.
These drugs fell into disuse because of the fatality factor in suicide attempts and the elevated QT risks with other drugs. When the SSRIs came out, with much less fatality risk, the tricyclics were dropped and this safety factor was presented to general practitioners. I attended seminars about this back then. Of course with time, the agitation caused by SSRIs and the "prozac" suicides by violent means, and domestic shootings, took over and increased deaths that way.

He didn't rule it out Mrs. D. he just said he didn't want to "chase" after medicines right now. i think they like to keep Medicines in their back pocket so they'll have options long term if you build up a tolerance to certain ones over time. I also have had bad responses to Cymbalta (suicidal thoughts, gastritis) and Lexapro (could not get out of bed) - all very low dose treatments. So, I think they are wary of any antidepressant with me.

I know i saw a clinical study that showed actual nerve regeneration from Elavil (amitriptyline) online. Was wondering why doctors aren't pushing it though? There is also significant evidence of dental damage from the dry mouth issues which concerns me. i try to trust their experience and not be completely anti-doctor. I will bring it up to him again, he has been very open to treatment options as opposed to previous neuros who basically told me to just get lost and go to Mayo clinic.

Hi,

I am jumping with an endorsement for Nortriptyline. As a metabolite of amitriptyline it has fewer side effects. I take it for nerve pain and have found it helpful. Gabapentin provided relief but had a depressing effect on my mood.

Keep after the docs till you find a med that brings relief and that you can tolerate.

I hope you feel better soon!
:hug:

There is a very good study on a combo plan of Nortriptyline and Gabapentin. http://www.medicalnewstoday.com/articles/165647.php

Doctors push Cymbalta because Lilly reps gave them gifts and money to do so. We have many ex-Cymbalta posters here and over the past years.

There are no reps out there educating doctors about new developments with amitriptyline or its metabolic cousin nortriptyline. If they don't go to continuing ed seminars on new medical treatments, they miss that boat entirely and so do their patients. In my world, many people get amitriptyline FIRST, it is considered, a first tier attempt to control pain. It is commonly used in migraine treatments.

http://livertox.nih.gov/Duloxetine.htm

Amitriptyline and nortriptyline have some liver potential too, but that typically shows up in the high dose antidepressant range of dosing and is much less severe. Cymbalta's potential shows up in regular dosing ranges.

If you want to remain drug free, that is your choice. I do that myself. But when I was working about 10 yrs ago and had a terrible attack of sciatica I did use doxepin in low dose for about 2 yrs to deal with that and to be able to continue working. Doxepin is another tricyclic and has less side effects.
It worked for me then very well.