Heat

What is it? It's heat, you know, warm temperatures. There are several possible ways of applying it to your body that basically break down into local application (wheat bags, hot water bottles, heat pads, Deep Heat, Tiger Balm - actually, technically the latter two just feel hot, but they have a similar effect on your body) and systemic application (saunas, steam rooms, heat lamps, sunny weather).

Does it work? As a temporary (partial) relief, yes. As a permanent fix, not so much. My experience is that when I'm having a bad day, especially if the problem is in my hips or my upper back, then a microwaved wheat bag applied to the sore area can reduce the level of pain I'm in or even, if I'm really lucky, temporarily completely fix the pain. It certainly makes sitting more comfortable. My favourite wheat bag is one like this for the upper back and shoulders, but I find its shape also makes it practical for the neck or hips or anywhere else I want to put it, and its large size means it retains heat slightly longer. I also own this electric back and neck heat pad with Velcro straps that covers the whole of my back and which is intended to be worn, but because of the fact it plugs into the mains I often just attach to the back of my office chair rather than my actual back. This is excellent for when I'm sitting in the office and want a longer lasting heat and, providing the instructions don't specify that you mustn't, you can also take it to bed and go to sleep on it (mine turns itself off after 90 minutes). However, it is less good than a wheat bag for pain in places other than my back. On top of that, I also own this massager with heat, although I find I don't use that so much, as the massager bits means it's not really comfortable enough to leave on my office chair all winter like I do with the heat pad. On the other hand, if our car's electrics worked properly and I could plug it into the car as is intended, I think it might be beneficial for long journeys. I don't find either Tiger Balm or Deep Heat as effective as a wheat bag, but I get the impression both provide me with some pain relief.
I also sometimes go and use my gym's sauna or steam room when I've got a lot of muscle pain and some spare time, and I've also been under a physio's heat lamp. Speaking as someone for whom heat works fairly well, I consider the wheat bag an indispensable part of my armoury, but the sauna and steam room is more of a pleasant extra that I have thrown in anyway with my gym membership. I'm not convinced that I'd actually pay extra money for the level of benefits it brings. I don't get the impression it has any real lasting effect, but I do often feel a bit better while in there and it is one of the more pleasant ways to spend time when I'm in too much pain to do much else. As for the heat lamp, I hated that with a passion. To use it I had to lie on a physio's table for about 30 minutes and then travel home in the -17° C temperatures Frankfurt was torturing me with that February. At that point, even lying down increased my pain, so as far as I can make out, this did not help me at all. It's certainly not something I would want to pay money for.

Who does it work for? This is another one for people with musculoskeletal pain, as one of the modes by which it works is probably by encouraging your muscles to relax. In particular, it may be good for hand, foot and joint pain, as they are less able to regulate their own temperature irrespective of any heat or cold you have applied to them (or for people with a hypermobility syndrome, as we in any case tend to regulate our temperature poorly and have a tendency towards Raynaud's phenomenon). If you have neuropathic pain and already own a wheat bag or a hot water bottle anyway, it might be worth giving it a try, as I think it may also work by distracting you from the pain (i.e. your central nervous system finds it hard to focus on the signals its receiving both from your pain and the heat at once and if you're lucky stops noticing the pain and only or mainly notices the heat). I'm not sure enough that this would work to recommend buying any equipment, but if you have it or can borrow it anyway, why not give it a shot and see if it has any impact?

Who doesn't it work for? Do NOT use this on inflammation (obvious trauma with redness and swelling) as this will make inflammation worse. However, according to Paul Ingraham, whose website I find very well researched and thoughtful, chronic pain is very rarely caused by inflammation, even when it's in your muscles, it's more likely to be muscle knots than inflammation. So bottom line: if you have a swollen, new injury, don't use heat on it, but you're likely to be pretty safe with chronic pain. This article suggests erring on the side of heat instead of ice for chronic pain. Also, I notice from my own experience that my experiences of cold have mainly been bad (I feel worse in winter) and that I look forward to heat in advance (all apart from that dreadful heat lamp where I had to lie in an uncomfortable position). Basically, as these things mainly work while you're doing them, with maybe a temporary after-effect, if you're applying a temperature that makes you feel worse, stop doing it immediately!

Where can I get it? You can get wheat bags, heat pads and water bottles online or from shops such as Argos. You'll sometimes also find wheat bags on market stalls. Deep Heat and Tiger Balm are available online, from pharmacies and from larger supermarkets. Most gyms have saunas and steam rooms and you may also find them at spas or hotels. You can buy your own heat lamp or you may be able to get treatment at a physiotherapist or similar therapist (my treatment with a heat lamp was in Germany, and I've never heard a single physio or osteopath mention one in the UK). I can't recommend heat lamps from my personal experience.

How much does it cost? You can get a standard wheat bag for as little as £5.18 or a neck, shoulders and back one like mine for £14.90. Don't forget, you also need a microwave to use them plus the cost of the electricity to microwave them. Alternatively a hot water bottle can cost as little as £2.38 plus the electricity to heat the kettle. If it's possible for you, I strongly recommend a wheat bag over a hot water bottle because they mould better to your body. My electric heat pad for my whole back costs £31.99. Ones for smaller areas, such as the lower back, may be cheaper, such as this one for £19.99. I recommend against click heat pads such as this one  because you need to heat them in water in a pan not the microwave to restore them and I also found that I had frequently left a tiny crystal in it, so when I came to use it, the whole thing had recrystallised and needed to be heated again. These are more for places where you don't have access to a microwave, for instance camping. If you don't have access to a microwave and if you don't mind the constant reheating in a pan, this may be a better option for you than a water bottle, but I'm not really sure the extra mouldability outweighs the difficulty of having to heat it in a pan between uses.
Saunas and steam rooms are generally available as part of gym membership. Other than that, spas sometimes offer access to steam rooms or saunas, such as in this £19 package (don't do the cold parts, you'll reverse any the good you just did by making your muscles tense up, also if you then go back out into cold weather my experience suggests you may also reverse all the good you've done, so I'm not convinced these things are worth a special trip for in winter). If you already have an electric blanket, that can also help, although I wouldn't recommend it as a first choice of products to buy for heat treatment.

Is there a cheap or free version? The free version is to dress warmly and/or sit under a blanket (which is better than not doing anything, but not nearly as good as a hot water bottle or wheat bag). Alternatively, go and sit outside when it's warm and sunny. The next cheapest version is a hot water bottle for £2.38 (although if money is a real problem, don't forget to factor in the cost of boiling the kettle). To my mind, if you have or can get a microwave, the wheat bag is the most cost-effective choice (by the way, it really doesn't matter if it still smells of lavender or not for your heat treatment, and if you're not too fussed whether it still has a lavender smell, a wheat bag will last for years and years). You may also be able to save a small amount of money by making your own wheat bag, for instance of rice.

Is there any evidence for it? It's not really been the subject of many trials, but what evidence there is is at least mildly positive.  This randomised controlled trial showed that one form of heat treatment, in this case infrared therapy, was more effective than placebo in reducing pain in people with chronic low back pain. Unfortunately, because they only tested infrared treatment, you can't be certain this result also applies to other forms of heat treatment. The only other trial I found for heat and chronic pain is still in the phase of recruiting patients. It will specifically look at heating/cooling therapy for people with chronic low back pain.  A 2010 randomised controlled trial showed ice and heat packs were both a little bit beneficial on neck and back pain in people with acute pain in a hospital, another randomised controlled trial found the inclusion of a heat wrap in treating acute low back pain helpful, and this one found continuous low level heat wrap therapy helpful in the prevention or early phase treatment of pain after exercise. None of this is as useful as evidence that shows benefits of treatment using heat for chronic pain specifically, but it is enough to suggest that heat is worth considering as a treatment for pain, especially if it doesn't cost you much to try it.

Are there any downsides? If you're silly about it you could scald yourself, so don't pour boiling water all over yourself when filling a hot water bottle, and if your wheat bag or hot water bottle feels too hot, take it off your skin until it's cooled down or wrap it in towels or jumpers until it doesn't feel too hot or until it cools down. If an electric device feels too hot it's probably broken, so throw it out or get it repaired. Don't heat your wheat bag so ridiculously hot that you risk starting a fire either. Don't sit in the sun so long that you get sun burnt or heat stroke and don't stay in a sauna or steam room for longer than recommended (or go in one at all if there are medical reasons why you shouldn't). In addition, if you don't have the capacity to tell if something is hazardously hot for any reason, always get someone else to test your device to see if it is too hot to sensibly use before using it, or you could hurt yourself or accidentally burn your house down. Basically, don't stop doing all the sensible things you normally do to not get burnt or heat stroke or heat exhaustion or dehydration just because you're using heat for medicinal purposes.
Also, this is probably just a temporary masking method that doesn't heal the root cause. But then again, if there were non-temporary fixes for our chronic pain that healed the root cause we wouldn't have chronic pain in the first place, so let's not dismiss cheap, temporary masking methods too quickly.
One final thought for women, if overheating tends to give you thrush, you'll probably want to be careful with where you use the heat source and not overheat your body as a whole.

Are there any other upsides? This is drug-free, cheap method of reducing pain. Also, it's lovely to be warm.

Was it worth the money? Definitely, particularly the wheat bag (although I wouldn't do the heat lamp again unless you paid me).

Do you have any experiences of using heat to treat pain? What does it work for? What was a pointless waste of time? What heat source would you recommend using or steering well clear of?

Pilates

Does it work? It depends what sort of pain you have. If you have lower back pain or if your pain has anything to do with poor posture and/or weak muscles, then, yes, Pilates is likely to work for you. If your pain is completely unrelated to muscle or posture problems (including tense muscles), then other than generally improving your health it's not likely to do much for you. Also, a warning from my personal experience of Pilates: depending on the cause of your pain, you may have to significantly modify it so as not to cause yourself even worse pain problems (this particularly applies to anyone with a hypermobility syndrome, as all that stretching can be a problem for us - see the top of page 7 of this PDF.). If you find yourself in more pain after Pilates, talk to your teacher about how you can modify it to suit you. I'm not sure how well Pilates works for my chronic pain, but I've done it on a regular basis for several years, as if I don't I tend to end up in physio with the physiotherapist prescribing Pilates-style exercises for the various acute pains I end up developing without it.

What is it? Pilates is a physical fitness system that uses low impact exercises and has a particular focus on the core muscles - the ones you need to sit and stand and do every day activities - and stretching. The aim is to build strength in your core muscles and attain better posture, balance and flexibility. Pilates can be done just on a mat or can involve a wide range of equipment. It can be done by people of all ages and levels of ability. I've been in classes with everyone from fit young men and women to old people who need help getting up and down from the floor (although a word of warning to shy men: group classes usually only contain between zero and two men in them, not because it's unsuitable for men, just because it typically attracts women). Many Pilates exercises can be done at different levels, and in a mixed ability class I find the teacher will often explain how you can make the exercise harder or easier, depending on your own level of fitness and strength. As my Pilates teacher frequently says, we're all different, so we all come to the class with different needs. Pilates classes typically have a focus on doing the exercises in the proper form to get the maximum out of each exercise and concentration on what you are doing, which is also a handy approach to bring to any other exercises you do.

Who does it work for? It is often recommended for people with lower back pain. People whose pain is due to weak muscles (particularly in relation to posture) may also be helped because it strengthens your muscles, particularly the ones you need to sit and stand up properly. Also, if you have a lack of flexibility for any reason, Pilates may be able to help because of its focus on flexibility and stretching. Its flexibility exercises and core strength exercises have the potential to improve your posture, which may in turn improve your pain levels if any of your pain is caused by poor posture, muscle weakness or areas of your body taking the strain because other areas are out of shape or not flexible enough.

Who doesn't it work for? Anyone whose pain is not caused by musculoskeletal or postural problems. In particular, anyone with neuropathic pain. (That doesn't mean people with other sorts of pain should avoid Pilates, it just means it's only likely to work for you as exercise and postural help and not as a pain reliever).

Where can I get it? Pilates is taught in group classes in gyms and other places, such as church halls. Try googling the name of your local area and "Pilates" to find classes. Also check out local gyms, which tend not to advertise their classes in a way that comes up in online searches. Pilates is also taught one to one or you can get Pilates DVDs and practice at home. I have tried all three and my preference is the group classes, as often I turn out not to be doing the exercises quite right and a teacher can correct me, whereas an exercise DVD can't; plus Pilates teachers vary the exercises in classes, which is both more interesting and better for you than repeating the same workout over and over. I have also had individual Pilates classes because my severe pain problems and the unusual way my body works mean I need to modify the exercises a lot, and so I've taken one or two additional individual classes from my group class teacher so we can work out solutions for me. But if your body and pain fall more within the range of normal than mine, then you may well not need additional individual lessons. If you are new to Pilates, look for a beginners' class or a mixed ability class and don't forget to tell the Pilates teacher about any injuries before you start.

How much does it cost? It depends where you live, but expect to pay around £8-£15 per group class on a mat and £40-£70 for individual classes. Alternatively, some gyms offer Pilates classes as part of their membership package (and it may be cheaper to join than just attend classes elsewhere). If you go to classes, the provider will usually provide all the equipment you need, unless like me you need extra equipment to modify the exercises. (I use this ball, partially inflated, to avoid lying on my back, and a pillow to cushion my back when I do lie on it).

Is there a cheap or free version? Yes, a cheap one: you can use Pilates DVDs, such as this boxset for £18.99. I like the look of this particular boxset because it includes several lessons and is suitable for beginners. If you use a DVD, I suspect you may also end up buying a mat to do it on, such as this one for £12.99. (Words of advice from my Pilates teacher: Pilates is best done on a thick, soft mat.) Unless you're a natural when it comes to exercise or have plenty of existing experience, I recommend taking at least a few group classes if you can afford it to make sure you're doing the right thing.

Is there any evidence for it? Yes, for low back pain. Specifically, a review of 2 randomised controlled trials and a clinical controlled trial found positive effects, such as improved general function and reduction in pain compared to minimal intervention when applying the Pilates method in treating non-specific chronic low back pain in adults, and a review of 7 randomised controlled trials found Pilates produced better pain relief for non-specific lower back pain than minimal intervention, but no significant reduction in disability. The same review found Pilates to be no better than other exercises for pain. In general though, researchers think more high-quality randomised controlled trials are needed and I had difficulty finding trials that looked at any form of pain other than lower back pain.

Does the individual teacher matter? Yes. I've mainly had good teachers, but some are no good at all. After a good teacher has taken a class, I'll often feel that my muscles have been working hard (in particular I'm likely to work muscles in my abdomen so much that they protest either during the class or the next day). Also, good teachers often remind you to use your core muscles when you do the exercises (they might not call them that, but they're likely to mention things like using the muscles you use to stop yourself peeing or holding your tummy in). After a bad teacher has taken a class, I don't feel like my core muscles have any sort of a workout. If you're not sure if your teacher is a good one, try another teacher for comparison.

Are there any downsides? Yes. Obviously there's the cost. Also, especially when you're a beginner, you're likely to have a sore abdomen the next day from all the core strengthening work (this is perfectly normal pain after exercise). But there's also the risk of doing yourself further damage. Pilates exercises are low-impact, controlled exercises, but if your body is very vulnerable for any reason, you should approach even Pilates with caution, and in particular you should be wary of pain in your lower back either during or after the lesson and talk to your teacher about it. My experience is that Pilates teachers tend to be used to dealing people with pain and injury issues, but Pilates teachers are not medically qualified, so if you are particularly vulnerable to injury, then you do run a risk of further injury (mind you, in my case, the same can be said of doing exercises given to me by medically qualified people or just doing things around the house, some of us are just highly prone to injury). In my case, I learnt that exercises lying on my back, exercises and stretches involving my hips and stretching my lower back at all cause me a problem, so I now modify or leave out all the exercises that do this. Please bear in mind though, my HMS means that I am particularly vulnerable and most people who go to Pilates classes are unlikely to have major problems like mine.

Are there any other upsides? Yes, expect to improve your fitness and your posture, and you may also improve your flexibility and your balance.

Was it worth the money? For me, yes. I can't be completely sure that it's improved my pain, but I feel a lot more vulnerable and tend to be a lot more prone to injury in the periods when I don't take regular Pilates classes.

Have you tried Pilates? Does it help with your pain?

Vitamin D

Does it work? Yes, if vitamin D deficiency causes or contributes to your pain. I've heard people say boosting their vitamin D helped them. I don't think it made any difference to mine, but when the doctor tested my blood I was found to be vitamin D deficient and therefore started taking supplements. Vitamin D deficiency is generally bad for your health and in particular also means you're likely to be deficient in calcium because the body needs vitamin D to absorb calcium, so I now take it regularly anyhow, as, among other things, the same blood test showed I had low calcium levels despite eating a large amount of dairy. The way I look at it, I have enough problems already without adding calcium and vitamin D deficiency into the mix, so I'm going to keep taking it.

What is it? It's a vitamin. It's that one our bodies make from sunshine, although we also obtain it from some foods, such as oily fish and eggs. The sunshine link means that a lot of people who live in the north of the northern hemisphere or the south of the southern hemisphere are deficient in it, at least during the winter and spring months, and especially if they don't spend much time outdoors with their skin exposed to the sun (with or without sunscreen) and/or have a darker skin colour.

Who does it work for? People with a vitamin D deficiency if that's contributing to or causing your pain. In particular, that seems to be people whose symptoms include non-specific musculoskeletal pain, headache and fatigue.

Who doesn't it work for? People whose pain has nothing to do with a vitamin D deficiency. Doctors can give you a blood test to test if you're vitamin D deficient, but they can't test whether it contributes to your pain. You can test it for yourself by trying taking it for a few months and seeing if you notice a change. This is not entirely scientific, as you're unlikely to be able rule out other causes of changes in your pain, but I think it's worth a try and the nurse at the centre of pain education recommended that all of us get tested for vitamin D deficiency and take vitamin D supplements if we were low on vitamin D.

 
Where can I get it? From a pharmacy or a health food shop or online.

How much does it cost? The one I bought cost £12.99 for 360 daily pills, so that's around £12.99 per year. You can get smaller quantities for a lower price if you wanted to try it for a month or two to see if it helped. Some sellers charge significantly more, for instance £4.50 for 30 pills. Don't forget to check both the number of pills in the pack and the level of vitamin D each pill contains. I find similarly sized packs often contain massively different numbers of pills.

How much of it should I take? The NHS recommends taking a supplement of between 0.01 mg and 0.025 mg per day. Vitamin D is often measured in international units (IU). According to this website, 5,000 IU is equivalent to 0.125 mg, which means that at 5,000 IU I'm taking five times the absolute maximum the NHS recommends per day (i.e. 1000 IU), which means it's probably a good thing I don't remember to take it every day. On the other hand, Web MD says I should be taking between 600 and 4,000 IU per day. My guess is my NHS doctor would recommend the same as the NHS website. Overall, it looks like 5,000 IU is rather on the high side and I should look for a dose of 1,000 IU next time, such as this one.

There's more than one sort of vitamin D, which one should I take? According to Wikipedia, in humans the most important vitamin D compounds are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). According to an NHS source I found, vitamin D3 is the preferred one for treating vitamin D deficiency. (I in fact found several websites that said vitamin D3 is the right one to take, but the NHS one was the first where I was sure I could trust the source.)

Is there any evidence for it? Yes, but as is so often the case, the studies seem to show mixed results. Some studies say yes it works, others say no it doesn't. What they do seem to agree on though, is that vitamin D deficiency is prevalent in chronic pain sufferers, so the very fact you suffer from chronic pain may be enough reason to get yourself tested or even just to take it as a supplement without getting tested.

  
Are there any downsides? Not really. There's the relatively low cost (about £1 a month), but actually, if you have a vitamin D deficiency, even if it doesn't help you with pain, it should help you avoid other health problems. However, excessive vitamin D levels can be bad for you. If you are in any doubt at all, speak to your doctor either about getting a vitamin D test or about whether there is a sensible and safe level of vitamin D you should take without even knowing your vitamin D level.

Are there any other upsides? Yes, not having a vitamin D deficiency is generally good for you, and having a vitamin D deficiency can lead to all sorts of health problems.

Was it worth the money? For me, it wasn't worth it for the pain effects as it didn't seem to have much effect on mine, but it is worth taking so I don't suffer from the other health problems a vitamin D deficiency brings.

Have you successfully reduced your pain with vitamin D? How quickly did you notice a difference and what difference did you notice?

Amitriptyline (tricyclic antidepressants)

Does it work? Better for some people than others. Unless your doctor says it would be a problem for you, it's probably worth a shot to find out if you're one of those people it works well for.

What is it? Amitriptyline (also sold under the brand name Elavil) is a prescription-only drug (at least in the UK) known as a tricyclic antidepressant. The reason it's known as a tricyclic antidepressant is that it was first developed for people with depression and only later discovered to be effective for other conditions including chronic pain. Its effects include simply reducing the level of pain experienced by people with neuropathic pain and fibromyalgia. It also relaxes the muscles and improves sleep. I find that it both helps me go to sleep and helps me stay asleep (although the flip side of that is it also makes me need more sleep). It is not a medicine that has an instant impact. You have to take it regularly for it to have its effect. Some websites say you only need to take it for 1-7 days for it to have an effect, others say 2-6 weeks. My own experience is that I begin to feel the side effects within a week, but that painkilling effects can take 2-4 weeks. Also, my experience is that once I have got through the initial period, I can feel a difference about 20-30 minutes after taking the tablet each day. In my case, I feel my muscles relaxing and the pain falling away from them - not always 100% but a clear improvement over before I took the tablet. In fact, I often notice I have forgotten to take the tablet because I'm wondering why my pain's so bad tonight. I am not a medical professional, so please check with a doctor whether they consider this advice a suitable guide for you, but my advice to me when I first went on it based on what I know now would be:

• You need to take it every day for it to work and you won't necessarily notice a difference for 2-6 weeks or after taking each pill (taking it only "as required" when you're in pain is likely to do little more than give you a taste of the side effects).
• Try it for at least 6 weeks before deciding whether it works or not, unless the side effects are really bad.
• If the side effects are bad but not dangerous, try and live with them for 3 weeks if you can before making a decision about whether to carry on, as often side effects lessen over time (they can carry on improving after 3 weeks, but that's about my cut-off point for tolerance of waiting for bad side effects to improve). If the side effects are beyond what you can cope with and it is making your life miserable, then feel free to decide earlier that this drug is not for you, go back to your doctor and find out how to come off it without withdrawal symptoms. If you're undecided about whether the side effects are worth it, I recommend setting a date in your diary to reassess the situation after 6 months.
• Start on a low dose and be prepared to move up to a higher dose if the effects on the pain aren't strong enough or down to a lower one if the side effects are too high. For me the key decision as to whether to take a non-life saving drug (and working out the best dose) is one of whether the side effects and risks outweigh the benefits or vice versa.
• Set your phone alarm to tell you when to take it so you don't forget. This drug is incredibly likely to make you sleepy - but your sleepiest hours won't necessarily be immediately after taking it. Start by taking it three hours before bedtime and get earlier if you're finding it excessively hard to wake up in the morning, and later if you're finding it hard to stay awake until bedtime. Keep adjusting it until you've found the optimum balance between staying awake till bedtime and waking up in the morning. Mine is 3.5 hours before bedtime. You may also have to adjust your bedtime or getting up time if a side effect for you is that you need more sleep.
• If the amitriptyline starts to feel less effective, talk to your doctor about if there's room to increase the dose.

Who does it work for? People with:

• neuropathic pain
• fibromyalgia
• pain from tight/tense, unrelaxed muscles
• overactive bladder (for instance, it can significantly reduce the number of times you need to pee at night)
• irritable bowels (this is another problem that often comes with HMS and I've noticed that mine have been a lot less painful in the years since I've been on tricyclic antidepressants, although until researching this post, I didn't realise that might be why. The NHS doesn't recommend amitriptyline as your first choice of treatment, but does mention it if antispasmodic meds don't work)
• migraines or headaches  
• temperomandibular joint dysfunction
•  atypical facial pain 

Who doesn't it work for? Researchers don't seem entirely certain which sorts of chronic pain it doesn't work for (and goodness knows my pain doesn't always behave like medical theory says it's supposed to), so my feeling is that unless your doctor says there's a reason why it would be a problem for you, it would be worth giving it a 6 week trial to see if the benefits outweigh the downsides for you.

Where can I get it? Through a prescription from your doctor.

How much does it cost? As a prescription drug, in the UK it is free if you are entitled to free prescriptions or buy a prescription prepayment certificate (well worth it if you get regular prescriptions) or it costs the standard prescription charge, or 2 p to 4 p per tablet plus postage from an online pharmacy. Given that UK GPs usually prescribe it in packs of 28 you are better off buying it at that price than for the prescription charge if you can or getting a prepayment certificate if you have a lot of prescriptions. The medicine has been off-patent for many years, so the cost to the NHS is minimal. Here are some prices for the US.
 

Is there any evidence for it? Yes. Clinical trials show it works for various types of pain, including neuropathic pain (postherpetic neuralgia, diabetic neuropathy), irritable bowel syndrome, temperomandibular joint dysfunction, atypical facial pain and fibromyalgia.

What about other tricyclic antidepressants? For years I've heard doctors recommending amitriptyline for chronic pain. It seems to be the go-to choice. When I complained loads about the horribly dry mouth it gave me (which I now know only happens for me on 10 mg a day when I also take codeine, but happens every night on 25 mg), my doctor said I could try doxepin (she also said amitriptyline is known for giving people a dry mouth and doxepin is known for causing weight gain) and I said I'd rather get fat. I spent about 2 years on doxepin and put on about 1-1.5 stone (14-21 lb/6.3-9.5 kg) and found the pain relief pretty good (possibly even better than amitriptyline, although it's always hard to really pin down which factor is making you better or worse). Unfortunately someone then discovered that doxepin was a risk for people with long QT syndrome that could result in death. I don't have a diagnosis of long QT syndrome, but this was still considered an unnecessary risk, so I was taken off it (and immediately lost about a stone without really trying in less than 2 weeks). I've also tried lofepramine, but didn't last very long on it. As far as I remember, the reason I stopped taking it was that it had very little impact on my pain. I haven't tried any other tricyclic antidepressants, but theoretically others could work. Amitriptyline is, however, very much the well known one for chronic pain and the one that a lot of people take for it.

Are there any downsides? Hell yes. Like any med it has a load of possible side effects. I get the common side effects: it makes my mouth dry (in my case it makes it horribly dry if I take it at the same time as codeine or beta blockers, and I wake up with more dryness in the morning on 25 mg than I did on 10 mg, but most of the time it's OK so long as I don't take codeine or beta blockers). It makes me really tired/sleepy in the 12-15 hours after I've taken it and more tired than I would be without it the rest of the time (this is the one that's the biggest problem for me). It makes me quite a lot hungrier (which in my case equates either to weight gain or evenings spent feeling really really hungry, although I don't find it as bad as doxepin for that and my BMI is still less than 25). Also, they warn you on the info leaflet to avoid alcohol on the basis that you will be more affected and get more tired. I choose to interpret that as still drinking alcohol, but not as much as those around me - for instance choosing lower alcohol options or having only a couple of alcoholic drinks in an evening and the rest alcohol-free. Several of the meds I'm on increase the effects of alcohol, which in my case means I wouldn't dare drive after any amount of alcohol at all and anything more than two glasses of wine is likely to result in me falling asleep in my chair (and also two glasses of wine for me is equivalent to about a bottle or two of wine for a hardened drinker). If my pain were less bad, I might choose not to take amitrptyline at all, but as it is, I find the far from perfect level of pain relief it provides increases my quality of life by more than the side effects worsen it.

Are there any other upsides? Yes, I used to have to get up a lot to go to the toilet in the night (often as much as 6 times). Now I generally only get up between 0 and 2 times a night (most often 0). Also, given that it can help with irritable bowels, it may also be what's behind the improvement in the irritable bowel pain I get. Also, it improves my ability to go to sleep and stay asleep. I can also sleep through more pain than I can without it.

Was it worth the money/side effects? Yes. To me it was.

Do you use amitriptyline or another tricyclic anti-depressant for chronic pain? How does it affect you?