Pain is a vague term that is used to describe anything from a stubbed toe to the sensitivity and numbness of nerve pain. Generally speaking, analgesics (both narcotics or opioids and anti-inflammatory medications) can work in a variety of ways depending on the type of medication. For example, anti-inflammatories work to reduce swelling or pressure which could be the cause of pain. Rather than affecting the brain’s neurochemistry, it affects something called the COX enzymes, which is what causes inflammation by releasing too much of the hormone prostaglandin. The anti-inflammatory blocks this production. Pharmaceutical narcotics or opioids actually bind the receptors in the brain, which help to block the feeling pain.
Narcotics are used for more severe pain, while anti-inflammatories and steroids are used for mild to moderate pains. Narcotics are incredibly addictive and anti-inflammatories run the risk of creating gastrointestinal conditions like stomach upset and ulcers. However, anti-inflammatories are generally more safe because GI prophylaxis and prevention can be done.
Unfortunately, even pain medications have uncertain efficacy when it comes to chronic pain syndromes. For example, they generally don’t work very well for patients with fibromyalgia, treatment-related pain in cancer patients, neuralgia, and chronic low back pain. Either the pain is not caused by the areas those medications focus on, or the body has too high a tolerance for the medications. In either case, patients with medication-resistant pain symptoms with certain conditions have found Elavil (amitriptyline) to be widely beneficial.
Elavil (amitriptyline) is not a narcotic medication and is not addictive. It’s technically categorized as a tricyclic antidepressant, which means that it has three rings to its chemical makeup. Unfortunately, this makes it so patients are more prone to side effects, but it’s also a very effective medication. While it does treat mood disorders like depression and anxiety, clinical studies have shown immense benefit in patients with chronic pain conditions like postherpetic neuralgia, peripheral neuropathy, fibromyalgia, migraine headaches, and low back pain.
Tricyclic antidepressants work to regulate the chemicals, serotonin and norepinephrine in the brain by blocking acetylcholine (another neurotransmitter) and increasing serotonin and norepinephrine levels. While researchers have not been able to determine why or how these two neurotransmitters affect pain, the clinical trials using tricyclic antidepressants like Elavil (amitriptyline) in pain patients showed a significant improvement in pain symptoms. They believe that since these two neurotransmitters are major conductors in overall messaging through the body and are generally termed “feel good” hormones, a decrease in their level increases pain symptoms because there is nothing telling the pain to reduce or stop.
Patients who have pain resistant to traditional medications should speak with their physician about using amitriptyline as a trial run. It will not only help treat the pain symptoms, but elevate mood and help patients feel more hopeful with regards to treatment.
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