Depression is a common occurrence in a chronic pain condition, and insomnia is quite common in depression. If the individual with chronic pain is also experiencing clinical depression, treating the depression with psychological treatment and an appropriate antidepressants (antidepressant medication), if indicated, may also help with the sleep disruption as well as other symptoms of depression.
Even in chronic back pain patients who are not experiencing significant or clinical depression, sedating antidepressants are often used in low doses to help with insomnia as well as providing some analgesic (pain relieving) benefit.
The sedating antidepressants most commonly used to help with sleep include Trazodone (Desyrel), Amitriptyline (Elavil), and Doxepin (Sinequan).
It should be noted that when these medications are used for sleeping and pain relieving properties, it is in much lower doses than when used in the treatment of depression. Benefits of these antidepressants include:
- They are non-addictive
- Added benefit of providing some analgesic benefit as compared to the hypnotic class of medications discussed previously (which have no pain relieving properties)
- Do not produce physical dependence or tolerance
- Generally have a low incidence of side effects, especially when used in low doses.
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Some individuals do experience adverse side effects, including such things as dry mouth, blurred vision, a "hangover" in the morning, constipation, urinary retention, and nausea.