Neuropathic Pain
Medications
Nerve pain is hard to treat. Treatment usually helps but often does not relieve all of your pain. You may need to try a number of medications and therapies before you find the best treatment for you. Write your questions down and bring them to each medical appointment. Work closely with your health care provider or pain care team to find the best treatment for you.
The medicines used for nerve pain are somewhat different than those used to treat everyday aches and pains. These medicines include anti-convulsants (seizure medicine), anti-depressants, and local anesthetics. Although they were originally made to treat people for seizures, depression and medical procedures, these medicines are able to relieve nerve pain too. When nerve pain is treated with a drug that is usually used for other disorders, this is called off-label use.
Your health care provider's choice of pain medicine may depend on the type of pain you feel. For example, you may take one medicine for burning pain, but another type if your nerve pain feels piercing or stabbing. You may need to try a number of medicines before you find the right one. You may need to take a combination of medicines for the best relief of your pain. Even with medicine, you may still have some pain. The most widely used medicines for treating nerve pain are:
Anti-Convulsants
Anti-convulsants are drugs that were originally used to treat seizures (convulsions or epilepsy). Now, certain anti-convulsants are given to relieve nerve pain too. Anti-convulsants that are commonly used to treat nerve pain include:
Anti-depressants were originally used to treat depression and other related disorders. Now many of them are also used to treat nerve pain. This class of medicine may help in three ways: relieve nerve pain, improve sleep and decrease depression in people who have it. Three classes of anti-depressants that are commonly used to treat nerve pain are tricyclics, SSRIs and SNRIs.
Opioids
These drugs are often called narcotics. These are the strongest class of medicines for treating pain. You may be given an opioid as your first type of treatment or after trying tricyclics or other medicines first. You may take an opioid in combination with another medicine to manage your pain. Opioids have more serious side effects than other classes or medicine. There are also possible problems with addiction related to their use. Some side effects of opioids include dizziness, sleepiness, upset stomach (nausea), constipation and bloating.
Tramadol (Ultram)
Tramadol is sometimes called a "weak opioid" or "narcotic-like" medicine. It works much like a regular opioid in relieving nerve pain, but has less severe side effects. You may begin this medicine at a low dose. Your health care provider may tell you to increase the dose slowly to help prevent or decrease side effects. Some common side effects include dizziness, upset stomach, headache and sleepiness.
Topical Treatments
These are medicines that you put directly onto your skin. Topical treatments may come in the form of skin patches, creams, ointments or gels. When you rub in or stick them onto your skin, they may help to relieve nerve pain in the area where it is applied. Some commonly used topical treatments include Capsaicin cream (Zostrix, Capsin, Dorolac, Trixaicin), Lidocaine/Prilocaine (EMLA) cream, and 5% Lidocaine patch (Lidoderm, Lidopain). The 5% lidocaine patch is FDA-approved for treating post-herpetic neuralgia. It may also be used to treat other nerve pain disorders.
Other Medications
The medicines used for nerve pain are somewhat different than those used to treat everyday aches and pains. These medicines include anti-convulsants (seizure medicine), anti-depressants, and local anesthetics. Although they were originally made to treat people for seizures, depression and medical procedures, these medicines are able to relieve nerve pain too. When nerve pain is treated with a drug that is usually used for other disorders, this is called off-label use.
Your health care provider's choice of pain medicine may depend on the type of pain you feel. For example, you may take one medicine for burning pain, but another type if your nerve pain feels piercing or stabbing. You may need to try a number of medicines before you find the right one. You may need to take a combination of medicines for the best relief of your pain. Even with medicine, you may still have some pain. The most widely used medicines for treating nerve pain are:
Anti-Convulsants
Anti-convulsants are drugs that were originally used to treat seizures (convulsions or epilepsy). Now, certain anti-convulsants are given to relieve nerve pain too. Anti-convulsants that are commonly used to treat nerve pain include:
- Gabapentin (Neurontin) – In addition to seizure treatment, gabapentin is FDA-approved to treat post-herpetic neuralgia (PHN). It is also given in an off-label manner to treat many other nerve pain disorders. You may need to start this medicine with a low dose and then slowly increase it. You may begin feeling pain relief in as early as one week, or it may take longer. Take this medicine as directed. Following your health care provider's instructions for this and all medicines is the best way to know if it can help relieve your pain. In addition to relieving pain, gabapentin may also improve your sleep, mood and enjoyment of life. The most common side effects of gabapentin are dizziness, sleepiness and upset stomach.
- Pregabalin (Lyrica) – Pregabalin is related to gabapentin. In addition to seizure treatment, pregabalin is FDA-approved to treat diabetic nerve pain, post-herpetic neuralgia and fibromyalgia. It is also used to treat other nerve pain disorders. Like gabapentin, this medicine may be started at a lower dose and increased over time, and it has similar side effects.
- Other anti-convulsants – Anti-convulsants that may be given to treat nerve pain as an off-label use include carbamazepine (Tegretol, Epitol), lamotrigine (Lamictal) and phenytoin (Dilantin).
Anti-depressants were originally used to treat depression and other related disorders. Now many of them are also used to treat nerve pain. This class of medicine may help in three ways: relieve nerve pain, improve sleep and decrease depression in people who have it. Three classes of anti-depressants that are commonly used to treat nerve pain are tricyclics, SSRIs and SNRIs.
- Tricyclic anti-depressants – These include medicines such as nortriptyline (Aventyl, Pamelor) and desipramine (Norpramin). Your health care provider may give you one of these medicines because they tend to be very effective in managing nerve pain. Other tricyclics used to treat nerve pain include amitriptyline (Elavil, Vanatrip, Endep,), clomipramine (Anafranil), imipramine (Tofranil), doxepin (Sinequan, Adapin) and trimipramine (Surmontil).
- Selective serotonin reuptake inhibitors (SSRIs) – These anti-depressants tend to have fewer side effects than tricyclics. These and SNRIs are a newer types of anti-depressant that health care providers are using to treat nerve pain. You may be given an SSRI or SNRI if tricyclics or other medicines did not relieve your nerve pain. SSRIs that may be used to treat nerve pain include citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac) and paroxetine (Paxil).
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) – These include duloxetine (Cymbalta) and venlafaxine (Effexor). Duloxetine is FDA-approved for treating diabetic peripheral neuropathic pain (diabetic nerve pain).
Opioids
These drugs are often called narcotics. These are the strongest class of medicines for treating pain. You may be given an opioid as your first type of treatment or after trying tricyclics or other medicines first. You may take an opioid in combination with another medicine to manage your pain. Opioids have more serious side effects than other classes or medicine. There are also possible problems with addiction related to their use. Some side effects of opioids include dizziness, sleepiness, upset stomach (nausea), constipation and bloating.
Tramadol (Ultram)
Tramadol is sometimes called a "weak opioid" or "narcotic-like" medicine. It works much like a regular opioid in relieving nerve pain, but has less severe side effects. You may begin this medicine at a low dose. Your health care provider may tell you to increase the dose slowly to help prevent or decrease side effects. Some common side effects include dizziness, upset stomach, headache and sleepiness.
Topical Treatments
These are medicines that you put directly onto your skin. Topical treatments may come in the form of skin patches, creams, ointments or gels. When you rub in or stick them onto your skin, they may help to relieve nerve pain in the area where it is applied. Some commonly used topical treatments include Capsaicin cream (Zostrix, Capsin, Dorolac, Trixaicin), Lidocaine/Prilocaine (EMLA) cream, and 5% Lidocaine patch (Lidoderm, Lidopain). The 5% lidocaine patch is FDA-approved for treating post-herpetic neuralgia. It may also be used to treat other nerve pain disorders.
Other Medications
- Acetaminophen – This medicine is an over-the-counter (OTC) drug that you may buy in pharmacies and grocery stores. It is used to treat pain and fever. Taking this medicine alone is not very effective for treating nerve pain, but it may help if combined with other nerve pain drugs.
- Bacoflen – This drug is used to treat muscle spasms. It may also help relieve anxiety and sleep problems as an added effect of decreasing your pain.
- Mexilitene – This is a form of lidocaine (anesthetic) that can be taken by mouth. Research studies are currently being done to learn its effect on nerve pain disorders such as diabetic nerve pain.
- Nonsteroidal anti-Inflammatory drugs (NSAIDs) – These drugs may help relieve pain, redness and swelling (and also fever). Taking this medicine alone may not be very effective for treating nerve pain, but it may help if combined with other nerve pain drugs. Many NSAIDs are over-the-counter (OTC) medicines with familiar names that you may have read about in magazines or seen on TV; others are available by prescription only. Read about some examples of NSAIDs used to treat nerve pain.