Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Dysfunctional Doctor-Patient Relationship

The use of Elavil (amitriptyline) for the treatment of back pain appeared in the literature many years ago. It was believed at that time that the drug served several functions:

a. It assisted those patients who were depressed

b. Even if not depressed, it promoted sleep

c. It was believed to be effective in reducing the experience of pain.

However, amitriptyline has some bothersome side effects:

Àô It does not promote effective sleep, merely a groggy like drowsiness that for some patients lasts much of the following day

Àô Patients have a variable response to it, and some cannot tolerate even very low (Eg. 25mg) dosages and are often started at 100mg+

Àô Elavil is associated with increased appetite, and quite often the last thing these patients need is weight gain

Àô It has several other side effects including annoyingly dry mouth, sometimes blurred vision and occasional problems with urination

There are antidepressants which are more effective in managing mood. There are others which are certainly more effective in promoting appropriate stages of sleep (called _sleep architecture), and many of the newer drugs have minimal side effects

When prescribing amitriptyline, one needs to determine whether the Elavil itself is not promoting some of the very things that would interfere with recovery.

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