Amitriptyline has actually been used as a pain medication for some time. Its mechanism of action isn't completely clear, but it does seem to be separate from its antidepressant properties. A dosage as small as 10 mg at bedtime is often used as a starting point, though some patients may need up to 100-150 mg per day. Anticholinergic side effects are common limiting factors in using amitriptyline. It's important to indicate to the patient that the medication isn't likely to start working right away -- a course of at least two to three months on the maximal tolerable dose should be your initial target. Other tricyclic antidepressants have been tried in pain management with varying degrees of success, though the selective serotonin reuptake inhibitors (SSRIs) haven't consistently shown any benefit in this respect. LW