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Best Medications for Nerve Pain

cartoon man in bed at night getting pain in foot

According to the Centers for Disease and Prevention, chronic pain is one of the most common reasons adults seek medical attention. More than just the physical aspect, people with chronic pain also carry a psychological burden. There are many causes of chronic pain. In some people, chronic pain is neuropathic in origin; in other words, the pain signals originate from the damaged nerves. According to a study published recently in the Journal of Pain Research, nearly 10% of people suffer from chronic neuropathic pain. The good news is that several effective pain management strategies can help improve the quality of life in people who suffer from neuropathic pain. Please continue reading to find out which medications effectively treat nerve pain. 

What causes neuropathic pain?

Pain occurs when body tissues are damaged. It is called neuropathic pain when the tissues of the nervous system are damaged or not functioning properly. 

Various health conditions can lead to nerve pain; diabetes is one of them. High blood sugar can damage nerves all over the body; this condition is called diabetic neuropathy. This type of nerve pain is very common in people with poorly controlled diabetes.

Some other conditions that can cause neuropathic pain include shingles (postherpetic neuralgia), alcoholism, stroke, multiple sclerosis, Parkinson’s disease, and HIV/AIDS.  There are also several types of nerve pain that are severe and more difficult to treat; some examples include trigeminal neuralgia (facial nerve pain), reflex sympathetic dystrophy, a type of chronic pain that occurs after surgery, stroke, or heart attack.

Certain medical treatments and medications can also cause neuropathic pain, for example, radiation therapy and chemotherapy drugs. Trauma, surgery, nerve compression by tumors, and nerve inflammation are other causes of neuropathic pain.

What does nerve pain feel like?

Many people describe nerve pain as a sharp, shooting, stabbing, electric-shock-like, or burning sensation that happens spontaneously. Other characteristics of nerve pain include numbness, tingling, and pins and needles sensations. These symptoms occur due to pain signals from damaged nerves.

Nerve pain can differ from person to person. People may describe their pain differently. Sometimes, nerve pain can happen spontaneously without any stimulation. Other times, nerve pain can be evoked by stimuli that are not supposed to be painful, like strong winds, cold weather, or low heat. In contrast, musculoskeletal pain is typically made worse by activity or movement. 

People with neuropathic pain may also experience hyperalgesia or hypoalgesia, an increased response to normally non-painful stimuli or decreased response to normally painful stimuli. They can also experience dysesthesia (unpleasant, abnormal sensations).

How do doctors treat nerve pain?

Doctors treat neuropathic pain by treating the underlying condition. For example, if a tumor is pressing upon a nerve and causing neuropathic pain, then chemotherapy, radiation therapy, or surgery to shrink or remove the tumor may provide relief. In people with diabetes, keeping blood sugar levels under control can prevent nerve damage and nerve pain. In addition, there are certain medications that are effective in treating neuropathic pain.

Can nerve pain medication provide pain relief?

Nerve pain medications can help to control severe pain and improve functionality and quality of life. However, in general, neuropathic pain is a complex condition and can be harder to diagnose and would require a multimodal approach including medications, physical therapy, counseling, and eventually surgery in some cases. 

Which medication is commonly prescribed for nerve pain?

Anti-inflammatory medications

Common painkillers such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen may relieve mild nerve pain. However, other pain relievers are more effective in treating pain signals originating from damaged nerve tissue.

Anti-seizure medications 

Anti-epileptic drugs (medications for seizure disorders) are very effective in treating nerve pain related to conditions like diabetic peripheral neuropathy, chemotherapy-induced peripheral neuropathy, and post-herpetic neuralgia. Examples include gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), topiramate (Topamax), and lamotrigine (Lamictal). The most common side effects of these medications include blurred vision, dizziness, lethargy, weight gain, and peripheral swelling.

Antidepressants

Doctors sometimes prescribe antidepressants, including tricyclic antidepressants like amitriptyline (Elavil) and nortriptyline (Pamelor); selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac); and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta); The extended-release formulation of venlafaxine (Effexor XR) has been found to be effective to treat nerve pain. 

Antidepressants are usually prescribed at a low dose for nerve pain and higher doses for the treatment of depression. A lot of people with chronic nerve pain also have depression due to the burden of this condition, in people. Therefore, antidepressants can be beneficial for people who have both of these conditions.

Side effects of medications used to treat depression may include indigestion, stomach ache, loss of appetite, dizziness, and headache. One thing to watch out for is that these medications can increase the risk of suicidal thoughts, especially in young adults, especially at the beginning of therapy.

Topical medications

Creams, ointments, gels, and patches with ingredients like lidocaine or capsaicin can be applied to the painful area to treat neuropathic pain. Side effects of these topical treatments include skin irritation. Combination therapy with oral and topical treatments may be necessary to control nerve pain in some people.

Opioid painkillers

Opioid pain medications like tramadol or oxycodone are not the first-line therapy in treating neuropathic pain. This is due to the fact that opioid analgesics carry risks such as dependence, misuse, and addiction. In general, other medication classes are used first to treat nerve pain. Using opioid pain medications is reversed when all other therapies have failed.

Other treatments for nerve pain

Nerve blocks (injections of steroids, local anesthetics, and other medications) can be given to the affected nerves to block pain signals. In people who do not get relief from nerve pain medications and nerve blocks, treatments involve stimulation of a person’s spinal cord with electrical impulses; these treatments are usually referred to as brain stimulation, spinal cord stimulation, and peripheral stimulation. 

What's the best painkiller for nerve pain?

Tricyclic antidepressants like amitriptyline and anti-epileptic drugs like gabapentin and pregabalin are very effective at treating nerve pain. However, due to the complex nature of this type of chronic pain, a multimodal approach involves medicines, physical therapy, counseling, and surgery. You should discuss different types of medications and treatment approaches with your care team. The successful outcome is about choosing an effective combination of medications to go along with the non-drug aspect of the treatment plan.  

When to see a doctor for nerve pain?

In most cases, nerve pain develops gradually over time and can be evaluated on a non-emergency basis. However, any type of nerve compression requires immediate medical attention as it can potentially lead to loss of body function. Therefore, you should seek immediate medical attention if you experience symptoms like progressive weakness, numbness, or severe pain.

How do you get nerve pain to stop?

Besides nerve pain medications, the following measures may provide relief from neuropathic pain:

  • Plenty of rest and sleep
  • Warm baths
  • Stretching, yoga, and meditation
  • Massage and physical therapy
  • Change in posture
  • Ergonomic workstation

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964880/
  2. https://my.clevelandclinic.org/health/diseases/15833-neuropathic-pain
  3. https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm