Getting control of your nerve pain can be hard. Fortunately is that physicians have a great deal of reliable ways to treat it. These include medications, like prescription pain relievers or anticonvulsants and antidepressants, in addition to electrical stimulation and other strategies. So if you have nerve pain, whether it’s brought on by cancer, HIV, shingles, or another condition, take hope. Here’s a rundown of the prescription treatments that your doctor might recommend.
Medications used for epilepsy or depression might be handy due to their results on nerve signals, while anti-inflammatory medications – such as ibuprofen – normally are not. Opioid analgesics, sometimes called narcotics or painkillers, are an alternative in some cases however are not the first choice. Medication typically does not entirely remove pain.
Discovering the best medication – or mix of medications – to treat neuropathic pain often takes some experimentation. A low dose of medication is usually attempted first, since side effects tend to increase with greater doses. If more pain relief is needed, the dosage will typically be increased slowly. A number of these medications can take weeks to take full effect.
Anti-Epileptic Drugs (AEDs)
Medications used to control epileptic seizures are referred to as anticonvulsants, anti-seizure medications, or neuroleptic medications. These medications can also assist soothe nerve pain and are frequently a first-line treatment alternative. Anticonvulsant medications consist of:
- Carbamazepine (brand name Tegretol).
- Gabapentin (brand name Neurontin).
- Oxcarbazepine (trademark name Oxtellar XR, and Trileptal).
- Pregabalin (trademark name Lyrica).
- Topiramate, Topamax (brand name Qudexy XR, Topamax, and Trokendi XR).
Carbamazepine and oxcarbazepine are usually more useful than other medications in blocking the pain of trigeminal neuralgia. This condition in a facial nerve causes intense, abrupt, short-term pain.
Side effects of anticonvulsant medications include, however are not limited to, chest pain, constipation, confusion, sleepiness, nausea, heart issues, and severe allergies. Anticonvulsant medications are not advised for pregnant women.
We are learning that the same imbalances in neurotransmitters that can cause depression are also involved in chronic neuropathic pain. Moderate relief of neuropathic pain and pain-related sleep problems might be achieved with antidepressants, whether an individual has depression or not. Antidepressants decrease symptoms by fixing imbalances in the nervous system’s neurotransmitters.
The following types of antidepressants are typically prescribed for neuropathic pain:
- Tricyclic antidepressants treat diabetic neuropathy, post-herpetic neuralgia (shingles), and central post-stroke pain. These medications consist of amitriptyline (brand Amitril, Elavil), imipramine (trademark name Tofranil), nortriptyline (brand names Aventyl, Pamelor), and desipramine (trademark name Norpramin). The term tricyclic stems from the medication’s chemical structure.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) duloxetine (trademark name Cymbalta) and venlafaxine (brand Effexor) treat pain related to diabetic neuropathy. Venlafaxine extended-release is also beneficial in alleviating the pain of polyneuropathies.
- Combination therapy works well for some people. One such therapy, tapentadol (trademark name Nucynta), integrates elements of an antidepressant and an opioid. Studies have actually shown it to have some benefits over the opioid oxycodone.
- Selective Serotonin Reuptake Inhibitors (SSRIs). This group of medications is not usually the first choice by itself, but might be valuable in combination with tricyclic antidepressants or if other medications are not well endured. Choices consist of escitalopram (brand Lexapro), paroxetine (brand Brisdelle, Paxil, and others), and fluoxetine (brand Prozac, Sarafem, and others).
Side effects and risks with antidepressants might include, however are not restricted to, heart issues, constipation, sleepiness, light-headedness, weight gain, dry mouth, and nausea. Antidepressants also might increase the risk of self-destructive thoughts. Women ought to ask their doctor before taking antidepressants or any other medication during pregnancy.
Usually available as a patch, gel, or cream, topical treatments can be practical for localized neuropathic pain. The medication in these products is taken in into the skin, either numbing the area or relieving pain.
Topical treatments may be a good choice for individuals who can not tolerate or prefer not to take oral medication. Little of the medication reaches the bloodstream, so cognitive side effects are avoided. Multiple applications are normally needed for considerable pain relief.
Lidocaine (brand Lidoderm, Xylocaine, and others) and capsaicin (trademark name Zostrix, Trixaicin, and others) prevail topical treatments.
Flushing of the face along with swelling, burning, and other irritation in the area where the medication is applied are the most common side effects. Less common side effects consist of, but are not limited to, a cough, tightness in the chest/wheezing, and breathing problems.
Opioids can be valuable in certain cases, however are frequently discouraged due to the fact that of concerns about overdoses, abuse, reliance, and the impacts of long-lasting use. High doses of opioids usually are had to offer substantial pain relief for neuropathic conditions.
Opioids such as oxycodone (Oxecta, OxyContin), morphine (brand names MS Contin, Kadian, and others), and Tramadol (Ultra, Conzip, and others) treat diabetic peripheral neuropathy, post-herpetic neuropathy, polyneuropathy, and phantom limb pain. Phantom limb pain is pain that persists after a limb has actually been cut off.
Tramadol is categorized by the U.S. federal government as a narcotic, but is an artificial medication. It is typically considered as having a lower risk of dependence than typical opioids however may still be habit – forming.
Side effects and risks of opioids, such as sleepiness, constipation, vomiting, and nausea, cause some people to terminate the medications. There is also a risk of dangerous breathing problems, which can be fatal if the medication is combined with alcohol or a medication that has a sedating impact. Opioid use is not encouraged during pregnancy.
Other medications may be helpful in decreasing the varied types of neuropathic pain. Severe pain due to nerve irritation and inflammation can be assisted with corticosteroids, such as prednisone.
Medications for neuropathic pain might be delivered as an injection, through an implanted pain pump, or with a patch, along with by mouth.