Amitriptyline is an effective treatment for peripheral neuropathy, especially diabetic and postherpetic neuropathy. The most common treatment is to prescribe a tricyclic antidepressant (TCA) like amitriptyline for neuropathy because it has been proven in multiple studies to be effective at relieving pain in at least 75% of patients treated. Although amitriptyline is considered a TCA, it is prescribed for many other conditions besides depression including relief of chronic pain because of its analgesic effects.
Neuropathy refers to a disorder or misfiring of the nerves, often leading to painful symptoms. Many diseases and conditions can cause neuropathy, including diabetes, shingles, and cancer drug therapy. Some other causes of neuropathy include autoimmune diseases, vitamin deficiencies, and acquired immune deficiency syndrome (AIDS). Since some types of neuropathic pain do not indicate actual tissue damage, just malfunctioning nerves, a doctor’s main concern is treating and relieving the patient’s pain. This can be accomplished through the use of antidepressants, opiates, or anticonvulsant medications.
Doctors prescribe the TCA amitriptyline for neuropathy because it works as a noradrenergic and serotonergic reuptake inhibitor. Simply put, amitriptyline causes certain “feel good” neurotransmitters in the brain to stop being reabsorbed by the cells. This causes blood levels of the neurotransmitters to stay higher than they might otherwise, resulting in mood elevation and cessation of pain.
Some patients have problems with side effects when taking amitriptyline for neuropathy. A few of the most common side effects include extreme drowsiness, dry mouth, and weight gain. Although some side effects, like drowsiness, subside over time, weight gain and ongoing problems with concentration or memory sometimes cause patients to stop taking the medication. In cases where side effects are too severe, antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be substituted by the doctor. SSRIs and other medications can help alleviate pain, but may not be as effective as amitriptyline for neuropathy, although their side effects may be better tolerated.
Other TCAs work as well as amitriptyline for neuropathy, but have similar side effects because they utilize similar mechanisms for alleviating pain. Some of amitriptyline’s side effects may be beneficial to the patient, especially if he is suffering from insomnia, anxiety, or headaches. This medication is an effective treatment for all of these conditions.
Some doctors may boost the effectiveness of amitriptyline by prescribing complementary therapies, like transcutaneous electrical nerve stimulation (TENS), biofeedback, and acupuncture. Although most complementary therapies have not been studied specifically for relief of neuropathy, TENS has been shown in one study to help relieve neuropathic pain in up to 80% of patients. When used in conjunction with amitriptyline that percentage jumps slightly to 85 percent.
