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Pain killers
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===[[Tricyclic antidepressant|Tricyclic Antidepressants]]=== [[Tricyclic antidepressant]] (TCAs) are a group of medications which are licensed for many different conditions besides depression, including [[chronic myofascial pain]], [[dysautonomia]] ([[amitriptyline]], [[nortriptyline]], [[desipramine]]), long-term pain ([[amitriptyline]], [[nortriptyline]], [[imipramine]]), [[fibromyalgia]] (amitriptyline), [[Irritable bowel syndrome|Irritable Bowel Syndrome]] (amitriptyline, nortriptyline, [[doxepin]], and others), [[migraine]] prevention (amitriptyline, nortriptyline), [[nerve pain|neuralgia]] (nerve pain), and [[sleep paralysis]].<ref name=":3">{{Cite news | url=https://www.drugs.com/drug-class/tricyclic-antidepressants.html | title = Tricyclic Antidepressants: List, Uses & Side Effects - Drugs.com|work=Drugs.com|access-date=2018-10-01|language=en-US}}</ref> TCAs include [[amitriptyline]], nortriptyline or [[clomipramine]] are commonly used in [[ME/CFS]] to treat chronic pain and to aid regular sleep. ==== TCAs for pain in M.E. ==== Most patients with M.E. are extremely sensitive to medication; the International Consensus Primer for Medical Practitioners recommends starting with a lower initial dose of TCAs, and that they should be used short term only.<ref name="ICP2011primer" /><ref name="CCC">{{Cite journal | last = Carruthers | first = Bruce M. | last2 = Jain | first2 = Anil Kumar | last3 = De Meirleir | first3 = Kenny L. | last4 = Peterson | first4 = Daniel L. | last5 = Klimas | first5 = Nancy G. | last6 = Lerner | first6 = A. Martin | last7 = Bested | first7 = Alison C. | last8 = Flor-Henry | first8 = Pierre | last9 = Joshi | first9 = Pradip| date = January 2003 | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols|url=http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf#page=10|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=11|issue=1 | pages = 7β115|doi=10.1300/j092v11n01_02|isbn=0-7890-2207-9|issn=1057-3321|via=}}</ref> There is evidence that [[amitriptyline]], [[nortriptyline]] and [[doxepin]] are effective for pain caused by M.E.; like all TCAs benefits may not take effect for 2 to 4 weeks<ref name="CCC" /> The sedating effects of [[doxepin]] and [[amitriptyline]] may help patients with sleep problems remain asleep.<ref name="CCC" /> Side effects may be severe, and include morning or daytime sleepiness, dry mouth, [[weight gain]], and increase dizziness and [[orthostatic intolerance]].<ref name=":3" /><ref name="CCC" /> Amitriptyline may also cause [[cognitive dysfunction]], e.g. '''brain fog'''.<ref name="CCC" /> [[Nortriptyline]] causes the least side effects, and [[amitriptyline]] is particularly effective for people with [[fibromyalgia]].<ref name="CCC" /> Some guidance states these drugs should be avoided in [[weight gain|overweight]] patients with ME.<ref name="ICP2011primer" />
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