Posted by ed_uk2010 on December 13, 2014, at 3:53:39
In reply to Re: Starting Cymbalta, how much til it helps pain? » phidippus, posted by SLS on December 10, 2014, at 21:32:03
>I don't know why imipramine and clomipramine do not have reputations for treating pain. There is still much to learn about what these drugs do in the poorly understood brain. Elavil (amitriptyline)....
I think it's mainly a combination of custom and practice, and which drugs were chosen for clinical trials. Amitriptyline was chosen for many trials, possibly because it was also used to relieve insomnia associated with pain. Nortriptyline appears effective based on less evidence. I expect imipramine and clomipramine also work for certain types of chronic pain, but like amitriptyline, they are probably more suited to treating neuropathic pain than nociceptive pain. Not all types of neuropathic pain respond well, and treatment is often difficult. Diabetic peripheral neuropathic pain often responds better to ADs than other forms. Nociceptive pain, at least in the acute phase, isn't usually very responsive to antidepressants, more standard analgesics are often effective.
Among the types of nociceptive pain (which comes from peripheral pain receptors, not directly from nerves, the spinal cord or brain), are cutaneous/skin pain, somatic pain and visceral pain. Many types of pain are a complex combination, needing a equally complex combination of treatments. Somatic pain comes from the bones and joints, it responds particularly well to NSAIDs, and is one of their main uses. Visceral pain occurs when the internal organs are stretched, distended or damaged, it occurs especially in cancer and often responds best to opioids. Cutaneous pain responds to local anaesthetics and various combinations of other meds. NSAIDs are also useful for headaches (including migraine), menstrual pain, dental pain, acute post-operative pain and renal colic.
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