A Case of a Chemically Dependent Patient with a Thalmic Pain Syndrome Treated with Amitriptyline

Abstract

A fifty year old white male with a right sided thalamic pain syndrome became alcohol and benzodiazepine dependent in an attempt to alleviate the pain. He entered an inpatient alcohol and drug treatment facility where, in an attempt to treat this pain, he was placed on low dose amitriptyline. Comparison of results on a symptoms checklist (SCL-90-R) completed at amitriptyline dosages of 30 mg. and 50 mg. showed a statistically significant difference in the somatization scale (p = .029). The low dose of amitriptyline used, its low blood level, and the early onset of effect make it unlikely that its antidepressant action was a significant factor in this patient's pain relief. This is, perhaps, the first described case where low dose amitriptyline has been shown to relieve the thalamic pain syndrome in a chemically dependent person.

Chronic Pain and the Measurement of Personality: Do States Influence Traits?

“…Of the 35 studies, three [20,21,34] had quality scores below 65% (Appendices A1–A9). These three studies were not used to arrive at an overall quality score or to arrive at strength and consistence of evidence conclusions.…”

“…Of the 129 references found, 94 either did not relate to the subject area or did not have a pre‐ and postpain treatment personality measurement. The 35 remaining studies [13,15–18,20–49] were sorted into nine groups according to which personality test or inventory was utilized. It is to be noted that some studies addressed more than one personality test or inventory and were therefore utilized more than once.…”

Somatization, secondary gain, and chronic pain: Is there a relationship?

“…When measuring somatization in CPPs by questionnaire, the first and major problem is to be sure that the measured somatization is not pain dependent, ie, it is independent of pain and pain levels. There is significant evidence that somatization scores using the SCL-90 are pain dependent [66][67][68]. This is important, because the tendency to somatize is conceptualized as a personality trait.…”

Amitriptyline

“…142 .431 It is the most common complication of herpes zoster and occurs in an estimated 9 to 34% of infected patients.142.44-461 However, both the severity and the incidence of PHN are directly related to age;14SI 50% of patients aged 60 years and up to 75% of patients aged 70 Woodforde et al 1441 were the first to report the efficacy of amitriptyline 10 to 25mg 4 times daily in patients with PHN and depression. 142 .431 It is the most common complication of herpes zoster and occurs in an estimated 9 to 34% of infected patients.142.44-461 However, both the severity and the incidence of PHN are directly related to age;14SI 50% of patients aged 60 years and up to 75% of patients aged 70 Woodforde et al 1441 were the first to report the efficacy of amitriptyline 10 to 25mg 4 times daily in patients with PHN and depression.…”