Back Pain and Tricyclics

Antidepressants are used for treating many chronic pain conditions even when the symptoms are not caused by depression. Among the various antidepressants available, Tricyclics that are usually prescribed for pain, these drugs include:

• Amitriptyline

• Imipramine (Tofranil)

• Clomipramine (Anafranil)

Tricyclic antidepressants are thought to increase neurotransmitters in the spinal cord that reduce pain signals. They do not produce immediate effects, but once the appropriate dose is determined for the individual patient, favorable results may be seen within a week. The pain relieving action of these drugs is still not fully understood.

Read more details about Tricyclics.

TCAs have also been linked to sudden death syndrome in children. For this reason, many clinicians put them at the bottom of the list of ADHD medications for children. TCAs can also be risky for substance abusers. Before starting TCA treatment for children, doctors recommend getting a baseline EKG in addition to monitoring side effects.

Side effects

The side effect associated with Tricyclic antidepressants are usually mild. These may include:

• Dry mouth
• Drowsiness
• Constipation
• Weight gain
• Difficulty with urination
• Blood pressure changes
• Risk of severe mood and behavior changes, including suicidal thoughts (Young adults may be at a higher risk for this side effect.)

To reduce the risk of side effects, your doctor will prescribe a low starting dose and slowly increase the amount. Tricyclics are generally well-tolerated especially in low doses. The doses needed to induce pain relief are typically lower than the doses recommended for treating depression

All of the Tricyclics have the same side effects, but in varying degrees. To fully understand these potential side effects, they are grouped as follows:

• Anticholinergic- These side effects range from unpleasant (dry mouth, dry skin, blurred vision, and constipation) to serious (paralytic ileus, cessation of the movement of the intestine, which can lead to intestinal rupture and death; and urinary retention, inability to urinate, which in serious cases can lead to rupture of the bladder).

• Adrenergic- Side effects can include sweating, sexual dysfunction, and orthostatic hypotension-- sudden drop in blood pressure upon rising and a sensation of lightheadedness. This condition can lead to a fall and, in turn, to fractures, which can have serious medical consequences, particularly in the elderly.

• Antihistaminic- Side effects include sedation and weight gain.

• Miscellaneous- Other side effects include lowered seizure threshold, cardiac arrhythmia, hepatitis, rashes, sweating, anxiety, and elevated heart rate.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): A newer class of antidepressants, can relieve pain in many of the conditions that tricyclic antidepressants are indicated for. Though SNRI's have a better side effect profile, these drugs do not work quite as well as tricyclic antidepressants.