Re: TENS and Elavil

[Guest guest]

Hi Aricka:

Looking at your last post, I think you may not have been given all the

information from your doctors. I'll be corrected by list members who have a

closer background in medicine or are closer to medical information.

Elavil has nothing direct to do with your pain. It is an anti-depressant. What

it's purpose is is to alleviate the negative feelings associated with living

with chronic pain by helping your body replenish or sustain the levels of

naturally occurring chemicals in your body that govern the way you feel. The way

it was explained to me is this:

Your brain produces a chemical called seratonin <sp?>. This chemical is what

makes you feel good in certain situations, bad in others. The level of chemical

in your body is enough to allow you to sustain a certain amount of intellectual

damage which can be caused by stress, (good as in winning a lottery, bad as in

someone close dying), normal day to day living with it's ups and downs. The

amount of seratonin though is limited. Once you run out, you start feeling

depressed, grumpy, just plain rotten. Your body can only produce so much of the

stuff so in cases where you have prolonged illness or pain, you most likely will

not produce enough to cope. Moreover, your body produces this in small

proportions and very slowly. You can deplete it a lot faster than you can

replenish it. A couple of good night's sleep will not replenish the stock.

Elavil takes care of this by bringing those levels up ( I'm not sure if it

encourages the production of seratonin or just replaces it - someone else help

me here please). So Elavil has no direct relation with your pain. It will

neither reduce it nor increase it. It just allows you to feel you can cope

better with the emotional problems associated with chronic pain. Things like,

" why me " , " I can't go on " , " when will it end? " and so on. All things you have no

doubt thought about as we all have on this list.

The reason your doctor gets upset with you is that Elavil has to build up in

your system to be effective. Taking it when you feel like it accomplishes

nothing as it does not act that fast. I seem to remember that results are not

really consistent until you have been on it for 6 weeks or more. The dosage is

then adjusted up or down to what you need. Most of us here are probably on some

for of amytriptylin or other such as Elavil and we take varying amounts of it.

In my case, I just dropped from 125mg a day to 100mg. The reason for the

decrease is that I find that as time goes by I accept my situation more so it is

less of a stress and I wanted to try taking less meds. So far it works for me.

We also each have a 'good' and 'bad' time of day to take it. I used to take it

in the morning and I'd feel like I just wanted to go back to bed all day. I now

take it at night and my days are fairly good.

When I talked to my doctor about cutting down, I asked him why Elavil always

seemed to be the first thing prescribed to chronic pain patients, before even

dealing with the pain. He felt that the two are so closely linked that it has

become a natural thing to do. He felt it was almost the " chicken and the egg "

thing where you can't really say where the two (pain and depression) begin and

the other ends.

I trust someone will correct me on all of this if I am misleading you.

The TENS. Someone asked me once to describe the sensation. I have had a TENS

since it was called a SEVENS ( a little humour ). The best way I found to

describe it is this. Hold out your arm. Now gently touch the arm with the tip of

a finger...as lightly as you can. Did you feel that ? Of course you did. Now ask

someone to place their hands about 6 inches apart on your arm and gently but

quickly twist as if gently wringing out wet laundry. While they do this, touch

your arm again as lightly as before. You probably won't feel it because there is

so much more activity where your arm is being twisted.That's how the TENS works.

It sends electrical stimuli in the form of vibrations around the pain points

that make your brain sensitive to the vibrations and less so to the pain. It

does not work for everyone. In my case, it did wonders for a long time while I

was still fairly active, then over time, it became annoying. I found it to be

specially interesting when I'd been wearing it for a while and all of a sudden

the batteries would fail ! It was like someone had been holding me up and

suddenly let go ! Then there's the 'cattle-prod' syndrome, when one of the leads

comes off and lodges itself in your underwear ! ( I have low back pain and I

would wear the leads on either side of the spine about waist high right under my

underwear waist and down my legs ).

All joking aside, the TENS is something to try. It introduces no harmful

chemicals in your body, it's non addictive and you turn it off or on as required

giving you personal control over the pain. Of all the treatments I've been

subjected to, the TENS still remains one of my treatments of choice, probably in

part because " I am in control " . (By the way, it is used extensively to help

patients who have had muscle injuries as well.)

I don't usually make such a nuisance of myself and I'm counting on other members

to correct my mistakes but I hope this has given you another way to look at

possible treatments and perhaps explained some of the processes going on with a

part of your treatment.

Mike

[Guest guest]

Hi Mike...

My understanding, from what I've read and what my doctors have told me, is

that the use of drugs such as Elavil in treating chronic pain patients is

more to help with obtaining a good night's sleep than depression. The

dosage levels that are usually prescribed are not what are used to treat

depression...they use much higher dosages for depression. Also, today most

doctors treat depression with other drugs, usually the SSRIs like Prozac,

Paxil, Zoloft,.....or Serzone..which is not exactly an SSRI but somewhat on

the same order.

The need for a good night's sleep is important in treating chronic pain

because, as I understand it, when in pain we do not obtain the delta level

of sleep. This is where we get restorative sleep. We don't obtain that

level because we wake up, due to the pain, over and over and over and over

in the night...often we don't even know we're waking up. It's usually not

fully awake but interruptive enough to keep us from getting to the delta

level. The drugs such as Elavil or the trazadone I use, in small doses like

we take, help us to get to sleep and more importantly STAY asleep...and thus

reaching the delta level of sleep.

I also know that often doctors will use drugs like Elavil in a bit higher

dose than would be used JUST for sleep because, as you pointed out,

depression and stress which can lead to depression are very often companions

to those in chronic pain. Usually, as the person gains acceptance, learns

ways to reduce the stress, and finds a peaceful path, the depression and

stress goes away or is reduced greatly.

Serotonin, as you noted, plays a part also in how our bodies react to

chronic pain. The less serotonin we have in our system affects not only our

moods and can cause depression, but also affects the way we PERCEIVE pain.

I've been learning a lot about serotonin and the role it plays in our health

and life. If we can increase the level of serotonin in our system it can

help with not only these things but also insomnia and appetite control....

many things I gather from what I've been learning! There are other ways to

increase your serotonin levels and keep the serotonin active longer (that's

what the SSRI drugs do..keep the serotonin active longer) besides the

prescription drugs. I've been using something called 5-HTP for almost 3

months and have had some success with it. One place where I learned more

about serotonin was in a book that I got to learn more about 5-HTP......if

nothing else, the book was a great source of info about serotonin and how it

affects us. Helped me to understand why the doctors want to treat chronic

pain patients with those drugs.

As you note... no matter which medication you're taking it is important

that you take it daily....it won't do its best job if you don't. None of

these drugs or treatments are something that you can use only when you feel

you need them.

I'm not a doctor or any sort of health professional so I'm not guaranteeing

that anything I've said is 100% accurate but I am comfortable with what I'm

TRYING to convey here. :-)

BTW.. I too have a TENS unit. I agree with you completely that one of its

many benefits is that it gives you a feeling that you're in control of your

treatment. I praise the day that I got mine, I've had it for 7 years

now...not as long as you've had yours I'd guess, but I am thankful I had a

doctor that was on the ball and had me try one.

CULater!

Ruthie

===========================

Ruthie Cunliffe K2ZQ

ruthie@...

http://www.cunliffegroup.com/ruthie/

experimental web cam: http://www.cunliffegroup.com/ruthie/spy/

** A BALANCED DIET IS A COOKIE IN EACH HAND **

[Guest guest]

Mike, Arica,

Mike, I think you explained what goes on with elavil & the body (mind?) as

well as anyone could. I can relate to your rendition of the TENS " hog prod "

effect!

As a general practice, elavil seems to be almost a medical knee-jerk

response for chronic pain patients, though. There were some hot research

findings I guess about 15 years ago that combined with pain meds chronic

pain patients felt better. Another factor in possibly making elavil widely

used is that it is not very expensive, while the more sexy anti-depressants

are very pricey.

But there can be problems with elavil. Not everyone responds well to it

(me for instance). I took it for several years while going with the flow in

a cutting-edge pain clinic & never questioned why I was profoundly sleepy,

falling asleep at my desk at work, having to watch the times that I drove,

etc. Also, I had a bunch of very lousy side-effects. Saliva production just

about stopped & I could hardly talk most of the time, embarrassing me at

meetings & making my wife & kids very happy. I don't know whether it helped

my mood, unless wanting to sleep all the time is the opposite of

depression. But I was desperate & bought the whole program. Once I realized

that maybe something just wasn't right & talked with my doctors, I was

tried on a lot of other drugs, most with little positive effect, but less

negative ones. As I mentioned before, I am a " non-responder " with many

anti-depressants. About 2/3 of the other people in treatment that I knew

seemed to benefit from elavil & didn't have as much trouble with side

effects. By the way, there is medication that helps the side-effects, but

no one (including me) thought of having me take it.

I couldn't quite get enough understanding from Arica of why it was a

problem for her (Arica, are you tuned into this?) But my experience in

mental health was that at least 1/3 of the people treated with elavil had

enough problems with it to make it hard for them to take it as they were

directed. And Mike's description of how it works is quite right. For it to

have any anti-depressant effect, it has to slowly build up in your body.

But often side-effects (if any) come earlier, even initially. And for many

people it is heavily sleep-inducing. Usually a godsend for a pain patient;

and therefor it is usually taken before bed. I have gotten on my soap-box

about other traditional anti-depressants that can also be good & possibly

more easily tolerated, so I'll skip that lecture here.

But Arica, I'd sure like to know what your gripe with elavil is, because

despite how it seems when you first start taking it, if you are part of the

many who can benefit from it, annoying side-effects can greatly lessen or

vanish in the 6 weeks or so it takes to start making you feel better

emotionally (happier or just less distressed). And if you are having

problems with it, sounds like your doctor would probably be quite

responsive in helping you with it. If you don't tell him there's a problem,

he could have a hard time finding out.

And Mike, watch out for those worn-out TENS electrodes. They're the worst!

Ken

At 07:59 PM 8/26/98 -0400, you wrote:

>

>

>Hi Aricka:

>

>Looking at your last post, I think you may not have been given all the

>information from your doctors. I'll be corrected by list members who have a

>closer background in medicine or are closer to medical information.

>

>Elavil has nothing direct to do with your pain. It is an anti-depressant.

What

>it's purpose is is to alleviate the negative feelings associated with living

>with chronic pain by helping your body replenish or sustain the levels of

>naturally occurring chemicals in your body that govern the way you feel.

The way

>it was explained to me is this:

>

>Your brain produces a chemical called seratonin <sp?>. This chemical is what

>makes you feel good in certain situations, bad in others. The level of

chemical

>in your body is enough to allow you to sustain a certain amount of

intellectual

>damage which can be caused by stress, (good as in winning a lottery, bad

as in

>someone close dying), normal day to day living with it's ups and downs. The

>amount of seratonin though is limited. Once you run out, you start feeling

>depressed, grumpy, just plain rotten. Your body can only produce so much

of the

>stuff so in cases where you have prolonged illness or pain, you most

likely will

>not produce enough to cope. Moreover, your body produces this in small

>proportions and very slowly. You can deplete it a lot faster than you can

>replenish it. A couple of good night's sleep will not replenish the stock.

>Elavil takes care of this by bringing those levels up ( I'm not sure if it

>encourages the production of seratonin or just replaces it - someone else

help

>me here please). So Elavil has no direct relation with your pain. It will

>neither reduce it nor increase it. It just allows you to feel you can cope

>better with the emotional problems associated with chronic pain. Things like,

> " why me " , " I can't go on " , " when will it end? " and so on. All things you

have no

>doubt thought about as we all have on this list.

>

>The reason your doctor gets upset with you is that Elavil has to build up in

>your system to be effective. Taking it when you feel like it accomplishes

>nothing as it does not act that fast. I seem to remember that results are not

>really consistent until you have been on it for 6 weeks or more. The

dosage is

>then adjusted up or down to what you need. Most of us here are probably on

some

>for of amytriptylin or other such as Elavil and we take varying amounts of

it.

>In my case, I just dropped from 125mg a day to 100mg. The reason for the

>decrease is that I find that as time goes by I accept my situation more so

it is

>less of a stress and I wanted to try taking less meds. So far it works for

me.

>We also each have a 'good' and 'bad' time of day to take it. I used to

take it

>in the morning and I'd feel like I just wanted to go back to bed all day.

I now

>take it at night and my days are fairly good.

>

>When I talked to my doctor about cutting down, I asked him why Elavil always

>seemed to be the first thing prescribed to chronic pain patients, before even

>dealing with the pain. He felt that the two are so closely linked that it has

>become a natural thing to do. He felt it was almost the " chicken and the

egg "

>thing where you can't really say where the two (pain and depression) begin

and

>the other ends.

>

>I trust someone will correct me on all of this if I am misleading you.

>

>The TENS. Someone asked me once to describe the sensation. I have had a TENS

>since it was called a SEVENS ( a little humour ). The best way I found to

>describe it is this. Hold out your arm. Now gently touch the arm with the

tip of

>a finger...as lightly as you can. Did you feel that ? Of course you did.

Now ask

>someone to place their hands about 6 inches apart on your arm and gently but

>quickly twist as if gently wringing out wet laundry. While they do this,

touch

>your arm again as lightly as before. You probably won't feel it because

there is

>so much more activity where your arm is being twisted.That's how the TENS

works.

>It sends electrical stimuli in the form of vibrations around the pain points

>that make your brain sensitive to the vibrations and less so to the pain. It

>does not work for everyone. In my case, it did wonders for a long time

while I

>was still fairly active, then over time, it became annoying. I found it to be

>specially interesting when I'd been wearing it for a while and all of a

sudden

>the batteries would fail ! It was like someone had been holding me up and

>suddenly let go ! Then there's the 'cattle-prod' syndrome, when one of the

leads

>comes off and lodges itself in your underwear ! ( I have low back pain and I

>would wear the leads on either side of the spine about waist high right

under my

>underwear waist and down my legs ).

>

>All joking aside, the TENS is something to try. It introduces no harmful

>chemicals in your body, it's non addictive and you turn it off or on as

required

>giving you personal control over the pain. Of all the treatments I've been

>subjected to, the TENS still remains one of my treatments of choice,

probably in

>part because " I am in control " . (By the way, it is used extensively to help

>patients who have had muscle injuries as well.)

>

>I don't usually make such a nuisance of myself and I'm counting on other

members

>to correct my mistakes but I hope this has given you another way to look at

>possible treatments and perhaps explained some of the processes going on

with a

>part of your treatment.

>

>Mike

>

>

>------------------------------------------------------------------------

>