Health Do you have a problem youd like answered? If so, write to us at: Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB or email inspire@arthritiscare.org.uk Ask the doctor Whether its a health niggle or emotional problem, Inspires Dr Sarah Jarvis gets straight to the point Q I have had back pain for years and nothing has helped, including surgery. My doctor has just prescribed me amitriptyline, which I thought was anantidepressant. Geoff H, via email You can contact Arthritis Cares free Helpline on 0808 800 4050 for an informal chat in confidence. Were open Monday-Friday, 09:3017:00. For more information, visit arthritiscare.org.uk/ exerciseandarthritis Dr Sarah Jarvis answers: Amitriptyline was indeed developed as an antidepressant one of the so-called tricyclic antidepressants. This family of drugs is rarely prescribed for depression any more not because they dont work, but because at the dose recommended for depression, they cause many side effects, including tiredness, constipation, dry mouth and blurred vision. However, the licensed dose of amitriptyline for depression is 75-225mg. In the years since it was introduced, it has become clear that amitriptyline can also be very effective for pain especially pain caused by nerve problems. This includes long-standing back pain, which is often, in part, because of irritation or squashing of the nerve roots that emerge from the spine. The same applies to many tablets developed to treat epilepsy, such as gabapentin and pregabalin. Amitriptyline works for nerve pain by making the pain messages that arrive in the brain less intense. It often does this at very low doses I usually start by prescribing a dose of 10-20mg to be taken at night. Because the dose is so much lower than that used for depression, side effects tend to be much less common, and are usually fairly mild. Its worth persevering, if possible, for a few weeks, as side effects tend to wear off, and it can take a few weeks to work. It doesnt work for everyone there are very few drug trials of amitriptyline as pain relief. A best guess is it helps one in four people who takes it. When it does work, I have seen it provide very effective relief. Its not suitable for everyone it should be avoided if you have had a recent heartattack or have severe liver problems. But if your doctor has confirmed its suitable for you, I would definitely give it a try. Ask the expert Guy Brain is from Arthritis Cares Helpline team. You can call the Helpline free on 0808 800 4050 Q I feel stiff and sore, especially after sitting. Im 57 and recently re-married. Life was improving and now Im feeling worried. Any advice? Susan, via email For more information, go to arthritisresearchuk.org/shop/ products/publications or call 0300 790 0400. Guy Brain answers: If pain is worrying you, its often helpful totalkit over with someone medically qualified. Health and clinical psychologists also specialise in pain management. If your pain is the result of an injury, has been getting worse, or is affecting daily activities such as walking, then you should visit your GP. In some cases, a doctor may want to see how things go for a certain period of time, and then review your progress. You may have the option of selfreferring to a physiotherapy or musculoskeletal clinic, where you can get an examination, investigations and recommendations. Physiotherapy can improve your strength and flexibility, and theres evidence that keeping active will defend against some long-term health problems. Whoever you see will ask questions to work out what parts of your body are affected. You may be given medication, and you may be advised to correct your posture and change how you lift things. If your pain is particularly bad during flare-ups, you may be advised to try gentle exercises. Arthritis Research UK has a Keep Moving booklet with suggestions on how you can keep active as well as booklets on hip and shoulder pain, which include exercises and treatment suggestions.