Health Organization for Pudendal Education

Hi, Hope you can help. I have a couple of questions that wouldnt mind some opinions. After going through a very difficult 2 years i thought that things were improving. I am seeing a great Physio in Dublin and life was liveable again. I have been on Amitryptyline nearly 12 months which am concerned about. Each time i attempt to stop or reduce the withdrawal symptoms arent great but pain returns to previous levels. I am only on 10mg which i understand is low dose. I am concerned to remain on this forever and can find no data or recommendations anywhere online, would really welcome your thoughts. Secondly the physio has identified many trigger points in anal area (has always been my pain area). Does the identifying of trigger points rule out Pudendal? I am still getting conflicting reports as to what my problem is. Many thanks.

I have been taking amitriptylene at 25 mg nightly for some 12-15 years for nerve pain in my large toes and have not had any problems. They did try to raise it (actually double it to 50mg) to see if it would help the pudendal but then I had blurred vision, etc so they had me go back to my regular dose and try gabapentin. I did read in the AARP (forgot what the acronym stands for but for over 50 year olds) and they said it can be an issue for older (since I am now 50 ) I would say it may have been folks 60 or70+ years. Not sure about your other question. Good Luck.
Janet

ChrisUK wrote:Does the identifying of trigger points rule out Pudendal?

Chris, I don't think trigger points would rule out pudendal. I had lots of trigger points with PN.

Amitriptyline was developed in the late 50s and there is plenty of evidence that it is very safe.
I second what Violet wrote. 100% of the population has trigger points.

I also third what Violet wrote. PN/PNE requires more diagnostics than trigger points. Have you had any other tests for PNE and if so which ones? EMG, PNMLT, CAT scan pudendal nerve blocks, physical exam by somebody trained in PNE, SIJD test, Piriformis Test, etc. There are numerous tests, but having some of the first 4 tests mentioned are usually the most helpful tests for diagnosis. If you provide more information regarding symptoms, cause, etc, we may also be able to help you better. There's Always Hope.
Shawn

Hi Chris - I doubt very much that you need to be at all concerned about taking 10mg of amitriptyline daily for a year - this is indeed a very low dose. The effective dosage for depression is up to 300mg daily, after all. For pain relief, the usual dose is 10 - 50 mg so you really are right at the bottom of the scale here, and it is a very safe and well understood medication.