Amitriptyline For Sciatica: Everything You Need To Know

Amitriptyline is often prescribed for sciatica and other types of neuropathic (nerve) pain. If you’ve been prescribed amitriptyline for sciatica, or you’d like to learn more before starting a course of amitriptyline, you’ll find everything you need to know in this article. Here, we discuss how amitriptyline relieves sciatica, how much you usually take, what the side effects are and some other options for relieving sciatic pain.

Although the NHS can treat sciatica, waiting lists can be long, and many choose private healthcare providers. For expert advice on managing your pain, consider booking an appointment with Harley Street Specialist Hospital’s pain management unit.

Table of Contents

How does amitriptyline relieve sciatica?
What is sciatica?
How much amitriptyline do you take for sciatica?
What are the side effects of amitriptyline?
When should you avoid taking amitriptyline?
Alternative medications to amitriptyline for sciatica
Other ways to relieve sciatic pain
Improving sciatic pain at Harley Street Specialist Hospital

How does amitriptyline relieve sciatica?

Amitriptyline was originally developed as an antidepressant but is now mainly used as a pain medication. Hormones like serotonin and norepinephrine help to regulate pain, and amitriptyline works by increasing the levels of these hormones in your body.

Increasing levels of these pain-regulating hormones helps to lower the pain signals from your nerves to your brain. As a result, you experience less pain and can go about your day more easily, which improves your quality of life.

Amitriptyline works well on conditions involving central sensitisation, in which your nervous system becomes highly reactive and amplifies pain [1]. Chronic sciatica (lasting longer than 3 months) usually has an element of central sensitisation [2].

What is sciatica?

Sciatica is a condition in which your sciatic nerve becomes compressed and inflamed. This is usually due to an injury or lower back condition affecting your sciatic nerve. Usually, this affects one side, but sciatica that affects both legs (bilateral sciatica) occurs in rarer cases.

Symptoms of sciatica include shooting pain in your legs, pain in your lower back or buttocks, and numbness, tingling or weakness in your legs or feet. In some cases, sciatica can also cause groin pain. The severity of sciatic pain can vary from mild pain, to leg and lower back pain so severe you can’t move.

There are many potential causes of sciatica; some of these can affect everyone and some are specific to certain groups of people. For example, sciatica in pregnancy is a common cause of lower back pain in females.

How much amitriptyline do you take for sciatica?

Research suggests taking between 25mg and 75mg of amitriptyline daily is effective for pain conditions like sciatica [3,4]. Lower dosages are linked to fewer side effects, but these low doses may not be enough to relieve pain for everyone. The dose of amitriptyline is slightly higher when used to treat depression – usually 50-100mg daily, but this can go as high as 150mg under the supervision of a specialist [5].

Taking amitriptyline once per day is enough because it is a long-acting medication. Taking it before bed is best because it can make you sleepy [6].

Your doctor will support you in titrating your dose of amitriptyline, which means starting at a low dose and slowly upping it as needed. Usually, this reduces any side effects you may experience.

What are the side effects of amitriptyline?

You may experience side effects when taking amitriptyline [7]. Side effects are usually less common and less severe when taking amitriptyline for pain as opposed to depression, because doses are lower when treating pain [8].

Possible side effects of amitriptyline include:

Constipation
Dizziness
Feeling more tired or sleepy than usual
Dry mouth
Headache
Difficulty passing urine

These are common side effects and happen in more than 1 in 100 people who take amitriptyline [8]. Some of these side effects improve as your body gets used to the medication. If you are struggling with the side effects of amitriptyline, speak to your doctor or pharmacist.

Serious side effects of amitriptyline

Rarely, some people experience serious side effects from taking amitriptyline. You are unlikely to experience any of these side effects when taking amitriptyline, but it’s important to be aware of them [8]. Call a doctor or 111 if you experience [8]:

Yellowing of your skin or the whites of your eyes – this could be a sign of a liver problem
A fast or irregular heartbeat
Eye pain, swelling or redness in or around your eyes, or any change to your eyesight
Headache, weakness or confusion – this could indicate low sodium levels in your blood

Call 999 immediately if you, or someone you’re with, experiences [8]:

Weakness on one side of your body, difficulty speaking or thinking, loss of balance, or blurred eyesight – these may be signs of a stroke
A seizure or fit
Severe chest pain, which could be a symptom of a heart attack
Thoughts about self-harm
Signs of a serious allergic reaction (anaphylaxis) – swollen mouth or throat, struggling to breathe or swallow, confusion, drowsiness or dizziness, fainting

When should you avoid taking amitriptyline?

You shouldn’t take amitriptyline if you have a recent history of strokes or seizures if you have a heart rhythm disorder or if you’ve had a heart attack [9]. Amitriptyline can make you sleepy, so you should avoid driving or operating machinery if you’re tired.

It’s best to avoid drinking alcohol after you’ve taken amitriptyline because the effects of alcohol can be increased. Speak to your doctor or pharmacist about whether amitriptyline is suitable for you – it can interact with other medications, and your doctor or pharmacist can advise you whether it’s safe for you to take.

Alternative medications to amitriptyline for sciatica

There are several different types of medication that may be recommended instead of or as well as amitriptyline. Speak to your doctor or pharmacist for more information about the best option.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Your doctor or pharmacist will often recommend NSAIDs before prescribing amitriptyline. If the NSAIDs don’t effectively treat your sciatica on their own, or they’re not safe for you to take, you may be prescribed amitriptyline as well as or instead of NSAIDs.

Duloxetine

Duloxetine is a different type of antidepressant that can also be used for sciatica pain relief. Like amitriptyline, it increases levels of serotonin and norepinephrine in your body.

Research shows that duloxetine is one of the most effective drugs for chronic pain (pain lasting over 3 months) [10]. Side effects of duloxetine are similar to amitriptyline but also increase the risk of diarrhoea, nausea and sexual dysfunction [11].

Gabapentin and pregabalin

These are anticonvulsants (drugs to stop seizures) that can also treat neuropathic pain [12]. However, these drugs have significant side effects and amitriptyline may be more effective at treating pain [13].

Other ways to relieve sciatic pain

Although some painkillers can often provide near-immediate relief for sciatica pain, they don’t address the root cause of your symptoms. Sciatica is usually caused by an underlying spinal condition which needs diagnosis and treatment to cure sciatica permanently.

Diagnostic imaging is often required to diagnose the cause of sciatica accurately. Harley Street Specialist Hospital has a comprehensive diagnostic imaging centre with expert radiologists. We can help you start your journey to recovery by identifying the cause of your sciatica and the best treatment to resolve it.

Home treatment

Here are 4 methods for you to try at home that may relieve sciatica symptoms:

1. Ice and heat

Ice helps to reduce inflammation and numb painful areas, while heat reduces muscle tension. Do not use heat or ice on any areas of your skin with altered sensation due to the risk of damaging your skin.

Use each for no longer than 20 minutes at a time. Choose whichever method relieves your symptoms best – you can also alternate between the two.

2. Stay active

Although it’s sometimes tempting to avoid movement when you’re in pain, you need to stay active to improve your symptoms [14]. Sitting for too long puts pressure on your sciatic nerve, so try to change position every 20 minutes and get up as often as possible, even if it’s just for a few minutes.

3. Gentle exercise

Research shows that gentle exercise improves the symptoms of sciatica. Swimming is good for sciatica – research shows that swimming can help a damaged sciatic nerve to regenerate faster [15].

Walking and cycling regularly have been shown to protect against hospitalisation with sciatica [16]. Cycling and walking can improve sciatica symptoms as well. Keep your exercise at a tolerable level and stop if it worsens your symptoms. Check out these NHS-recommended exercises for sciatica to learn more about what to do.

4. Move mindfully

While your sciatica is recovering, it’s best to avoid rapid twisting movements or lifting heavy loads. If you need to lift something heavy, split it into several smaller loads where possible and make sure to bend your knees when you lift, taking the pressure through your legs rather than your lower back.

Physiotherapy

Physiotherapy for sciatica consists of a full assessment followed by a tailored programme of exercises for sciatica, lifestyle advice and treatments such as acupuncture for sciatica, manual therapy and massage techniques for sciatica pain relief.

If your pain is severe, particularly if your sciatica is so bad you can’t walk, physiotherapy may not be possible until your pain is under control. This is where painkillers like amitriptyline are useful – they make movement easier and less painful, allowing you to take an active part in your recovery.

Physiotherapy is known to be effective for sciatica [17], but it is often hard to get an NHS physiotherapy appointment due to high demand and long waiting lists. Harley Street Specialist Hospital has a team of experienced physiotherapists trained in treating sciatica. Book an appointment today for fast access to private physiotherapy.

Injections

There are various injections that can provide relief from sciatic pain. These include:

Steroid injections – These are injections containing anti-inflammatory medication. Steroid injections for sciatica can relieve sciatica caused by inflamed tissues, joints or nerves.
Nerve block – Nerve block injections block the pain signals from the target nerve (in this case, the sciatic nerve). This can help to interrupt the pain cycle and improve symptoms.
Platelet Rich Plasma (PRP) injections – This is an injection containing platelet-rich plasma from your own blood. The platelets from your blood are collected and condensed, then injected into the target area. This encourages faster healing and can help sciatica by treating the underlying cause.

At Harley Street Specialist Hospital, our dedicated pain management unit administers injections under ultrasound guidance. This means that imaging shows a clear picture of the painful area being injected, and the specialist can deliver the most accurate injection possible.

Surgery

Sometimes, surgery is required to cure sciatica permanently. The type of surgery varies depending on the underlying condition in your lower back causing sciatica.

Harley Street Specialist Hospital has a team of world-class orthopaedic spinal surgeons and neurosurgeons specialising in treating sciatica. If you need surgery, our team will put you at ease and provide the best treatment guided by your needs and preferences.

Improving sciatic pain at Harley Street Specialist Hospital

At Harley Street Specialist Hospital, we have a team of expert pain consultants and a dedicated pain management unit.

If you’re struggling with pain from sciatica, we can diagnose the cause of your symptoms and provide treatment. Assessment, diagnosis and treatment can often take place on the same day.