Amitriptyline by the grain

My husband George, who is 91, developed shingles a year ago. Although the doctor thought the shingles had been caught in time, the initial treatment did not have its desired effect. Paracetamol did little to affect the pain. Axsain cream was prescribed and then 25 mg of amitriptyline. Due to George’s heart condition (mitral stenosis) a diuretic was added two weeks’ later. As a result George suffered confusion, weakness and loss of balance. Our GP immediately took him off the amitriptyline and diuretic.

Our GP has in his waiting room, a large ring binder with masses of information from various groups. I had a look and came across Pain Concern. They responded to my inquiry with considerable information, including the address of the Pain Relief Foundation in Liverpool. I spoke to a Pain Concern volunteer who introduced me and hence our GP to the idea of starting with very small doses of amitriptyline. Our GP started George with just ‘grains’ of the tablet, gradually building it up. This procedure was followed over the next five weeks, building back up to 25 mg.

Because of continuing complications, George was referred to hospital. Here the amitriptyline was reduced to 15 mg; gabapentin and the use of a TENS machine were introduced; the diuretic was reintroduced.

Ongoing support provided by Pain Concern was essential to encourage again the gradual reduction of a medication or introduction of a new medication.