Chronic Pain

Medication: antidepressants and antiepileptics for chronic pain

Some people we talked to had been prescribed drugs which are usually used to treat either epilepsy (antiepileptics) such as gabapentin or pregabalin or depression (tricyclic antidepressants) such as amitriptyline and duloxetine. This is not because they have epilepsy or depression but because it has been discovered that these drugs can also help certain types of pain. NICE- National Institute for Health and Care Excellence (Guidelines CG173 updated April 2018) recommends that patients be offered: “a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain (except trigeminal neuralgia)".

Several people were using a tricyclic antidepressant drug for nerve type pain such as amitriptyline. People were keen to emphasise that these acted by damping down the nerve activity and were prescribed in much lower doses than would be used for depression. One man was disappointed that this had not been explained to him but had found information about it on the Internet.

People using an antidepressant commonly experienced a dry mouth and sleepiness. One woman found the dry mouth problematic because she often had to make presentations at work. She was concerned that reduced saliva might be affecting her teeth and had been given special toothpaste. Whilst sleepiness bothered some, others found it helpful, as their sleep had been previously disturbed.

Anti-epileptic drugs such as gabapentin (Neurontin) and carbamazepine (Tegretol) were sometimes prescribed for nerve pain. One lady with multiple sclerosis was using gabapentin to treat her nerve pain. Others used it to treat nerve pain due to an injury.

Carbamazepine is now recommended by NICE (CG173 updated April 2018) as an initial treatment for trigeminal neuralgia rather than gabapentin which is more suitable for neuropathic pain.

One woman describes her experiences of the side effects of gabapentin which included weight gain and dry mouth. She also felt that it may be affecting her memory but wondered whether this was to do with the pain.
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Last reviewed August 2018.

Last updated August 2018.


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