September 28, 2020

What medications are used to treat neuropathic pain?

Reviewed by the Transitional Pain Service team at the Toronto General Hospital
The contents of this website are for informational purposes only and do not constitute medical advice. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
If you have neuropathic pain, you don't have to go it alone. You can seek professional help to receive proper care and treatment. Before your doctor can treat the pain, he or she will need to treat the underlying cause first. For example, if a patient has diabetic neuropathy, the doctor will help you manage the condition first before administering any form of pain management.
There are many ways to treat neuropathic pain, with medication being the first thing that doctors will administer to patients. Finding the best medication may involve trying different medications at different doses, especially if the condition has already progressed. Most doctors will prescribe a low dosage at first to avoid any adverse side effects. If the nerve pain you are experiencing is mild, this will sufficiently treat your symptoms. However, if the medication does not sufficiently treat the pain, the dosage will be increased gradually.

Medication for Neuropathic pain treatment
Pain is unique to everyone, and the reasons behind neuropathy will vary. As such, there are many medications used to treat this condition. More often than not, these medications will need to be taken for the next couple of weeks before you can experience their efficacy. Depending on the situation, a doctor may also prescribe a combination of several medicines to improve the outcome of the treatment. You might even have to go through a trial-and-error process before your doctor can find the right combination. Over the years, medical professionals have also found out that certain drugs that were originally used to treat depression and seizure can also be used to dull the pain caused by damaged nerves.
Types of over-the-counter pain medication
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    Over-the-counter pain medication
    These are your typical run-of-the-mill pain relievers that can be bought without a prescription. Because these are well-tolerated by the body and have few side effects, they are usually the first medication prescribed by your doctor. The most common type of painkillers are aspirin, acetaminophen, and ibuprofen. If you are still in pain after taking this type of medication, it may be a sign that you need something stronger, so consult with your doctor to determine the best treatment option.
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    Topical medication
    This type of medication is for localized nerve pain and may come in the form of a cream, gel, or patch. The product is applied by hand to specific parts of the body, and is absorbed into the skin. This is the best treatment option for people who do not want to take any form of oral medication. Known side effects of this type of medication are an intense burning sensation and irritation on the area where it was applied. Capsaicin cream is a popular topical ointment used to treat nerve pain. It contains capsaicin, a substance found in chili peppers that is known to reduce the pain sensation. Lidocaine topical patches are also known to provide temporary relief from pain, but will need to be reapplied throughout the day.
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    Vitamins and supplements
    Nerve pain is sometimes attributed to vitamin deficiency. If your doctor determines this to be the cause of your pain, you may be prescribed vitamin B12 which may come in the form of injections or tablets. Alpha-lipoic acid is another antioxidant supplement that can also help relieve pain symptoms in some people.
Types of prescribed neuropathic pain medication
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    This type of medication is usually prescribed to people with epilepsy in order to treat their seizures. These drugs can also help blunt the pain by interfering with the transmission signals being sent by the damaged nerves. Some of the popular ones that are used to treat nerve pain are pregabalin and gabapentin. As with many medications you may experience some side effects when taking these drugs such as allergic reactions, chest pain, dizziness, drowsiness, nausea, and more. The epilepsy drug carbamazepine is frequently used to treat trigeminal neuralgia, a chronic pain condition in which a patient experiences a severe and sudden electric shock-like pain in the face.
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    This type of medication may still be prescribed by your doctor to treat neuropathic pain, even if you're not depressed. However, because neuropathy may severely impact the quality of your life, you may experience sleep deprivation and mood disorders such as depression and anxiety. The following classifications of antidepressants may be prescribed to treat these complications:

    o Tricyclic antidepressants – These antidepressants are used to treat nerve pain caused by diabetes, stroke, and shingles. Some of these medications include amitriptyline and nortriptyline.

    o Serotonin and norepinephrine reuptake inhibitors (SNRIs) – Escitalopram and fluoxetine are SSRI antidepressants that can also be taken for nerve pain.

    o Selective serotonin reuptake inhibitors (SSRIs) – Lexapro and Prozac are SSRI antidepressants that can also be taken for nerve pain.
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    This type of medication is often prescribed as a last resort. In fact, some doctors discourage prescribing it due to the addictive effects of their long-term use. Some examples of opioids are codeine, hydromorphone, oxycodone, morphine, and tramadol. Although tramadol may be viewed as the safest option among the four, it is still considered as habit-forming if used for a long time. The known side effects of opioids are constipation, drowsiness, nausea, and vomiting.
Living with neuropathic pain can be difficult to manage on your own, which is why you need to seek professional help. To get well, the first thing you have to do is to determine the underlying cause for your neuropathy. If the root cause is still reversible, then the damaged nerves can still heal and regenerate. Pain caused by nerve damage can be debilitating, but with the help from your doctor and with proper medication, you can experience major relief from pain.

Other non-medicated treatment options are also available, such as physiotherapy, massage, acupuncture, and mindfulness. These will serve as a complement to your medication in order to bring out the best possible outcome from your treatment plan.