How Do I Use Nortriptyline for Pain?

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  • Written By: Mary McMahon
  • Edited By: Shereen Skola
  • Last Modified Date: 13 August 2019
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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.


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Post 4

I have increased my Nortriptyline slowly up to 50 mg at bedtime. It has decreased my daily migraine pain to just a tight muscle feeling. Also, I have more stamina to do stand up and walking tasks at work (I was also born with clubfeet/dislocated hips and have had many surgeries). My side effects are dry mouth (which is allieviated if I drink enough water), blurry vision and some fogginess during the day, but I never get eight hours of sleep.

In summary, I would rather live with the dry mouth and blurry vision than the icky feeling of pain coming on and full blown pain!

Post 3

@donasmrs-- Sometimes nortriptyline can be used by itself for pain. I use it by itself and it works for me.

Yes, it is technically an anti-depressant but it's an anti-depressant that blocks pain receptors in the brain. So it helps reduce the intensity of pain that we feel. This is why it is prescribed off label. There are also other anti-depressives prescribed for the same purpose.

What dose did your doctor prescribe for you? I'm currently on 100mg per day.

Post 2

@donasmrs-- Ask your doctor. I'm not in the medical field, so I can't say anything about your situation. I just know that my sister take a low dose of this along with her seizure medication to treat pain associated with epilepsy seizures. It is also my understanding that it is not used alone when it is prescribed to treat pain, but your doctor knows best.

Post 1

My doctor has prescribed nortriptyline for me, but he didn't prescribe another drug to go with it. I also didn't know that this is actually an anti-depressant and not a pain medication until I had the prescription filled.

Did my doctor make a mistake? I will call his office tomorrow morning, but I don't see how this drug is going to help with my nerve pain by itself.

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