Pain Management Advice

So the NL gave me a script for nortriptyline more than a week ago and I have yet to even fill it because I am so conflicted, so I thought I would ask some advice.

I've been taking topiramate for more than a year, and I'm pretty sure that keeps the chiari headaches in check, I'm able to cope with that pain.

The syrinx pain however, seems to be worsening.

I have taken nortriptyline in the past, on a different NL's advice, for treatment/prevention of migraine. A short course, 9 month titrate up and down (I believe 70mg) and when I came off the drug I spiralled into the worst depression of my life. What followed was two years of more/different antidepressants till I got sorted and back to normal.

So needless to say, when new NL gave me the new script I was hesitant.

I voiced my concern, told her about stopping the nortriptyline last time, and she gave me this look of pity that said 'oh honey, you're not going to stop it this time'

So... what I'm asking is: is this my best option at this point? I'm gathering in my research that the kind of pain I'm experiencing doesn't improve rapidly after decompression surgery - and who knows at this point if I'm a candidate for decompression and when they might schedule me in.

For reference: I've got pain in the spine from the middle of my neck to between my shoulder blades with accompanying tingling radiating outward toward the shoulder blades, alternating tingling and burning sensations in the hands and feet. The spine pain is a 4 in the morning and 5 by the end of the day.

The script she gave me was for 10mg for 7 days then go up to 20mg,

Thoughts? Advice?

If you think you can stand the pain I honestly might wait for the referral to the NS before I made a decision on that. A lot of time a syrinx shrinks post-op and while it's true that some nerve damage is permanent sometimes early damage can reverse itself so there might be hope that you won't need this medicine the rest of your life!