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Patients can use nortriptyline as a maintenance medication to limit incidents of breakthrough pain associated with nerve damage. It is an example of an adjuvant medication, which means that it must be taken alongside another drug and does not work effectively on its own. In a 2010 study sponsored by the Mayo Clinic, researchers found that nortriptyline for pain could be extremely effective when taken as directed, and should be considered a first-line treatment for the management of chronic neuropathic pain.
This medication is an antidepressant medication that appears to be effective for off label uses as well. Nortriptyline for pain is technically an off label use, as it is not recommended by the manufacturer and extensive studies have not been conducted by pharmaceutical companies to make dosing recommendations and make safety determinations. Pain specialists recognize the effectiveness of the medication and publish recommendations regarding its use in clinical journals used to inform doctors about available treatment methods.
Neuropathic pain can cause numbness, tingling, stabbing, or fiery sensations. It can be extremely painful and occurs in one to three percent of the population as a chronic condition. This type of pain is difficult to treat and many patients do not experience adequate pain relief. Doctors who specialize in the management of chronic pain may recommend both maintenance medications to prevent outbreaks along with as-needed medications used during breakthrough pain.
When a doctor recommends nortriptyline for pain, the patient typically takes it with a medication like gabapentin. Patients may prefer to take their medications before bed, as they can feel sleepy and disoriented after taking a dose. The drug is taken once a day, and should provide control throughout the patient's waking hours. If breakthrough pain increases while on nortriptyline for pain, it may be necessary to adjust the dosing or try a different medication.
It may be necessary to start with a low dosage and gradually increase to find that point at which nortriptyline for pain is effective with the lowest possible side effects. Patients should take the drug at the same time every day. If they miss doses, they can make them up, unless they are close to the scheduled time for the next dose. Nortriptyline doses should not be doubled up, as this can cause severe side effects. It is also important to adequately control breakthrough pain with the appropriate medications, to keep the patient comfortable when the nortriptyline is not able to provide enough pain management.