If you experience nerve pain, neuropathy, or neuropathic pain, several medications can help improve your discomfort. Doctors can recommend various drugs, and — in some cases — they may prescribe a combination of them to treat your nerve pain.
The medications doctors typically recommend include anticonvulsants, antidepressants, and pain relief, such as mild opioids. It is important to know that opioids can be habit-forming so should only be used as a short-term treatment option.
Doctors can advise what medication may be the most appropriate to treat nerve pain, depending on the location and severity of your discomfort.
Anticonvulsants
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Anticonvulsants are medications that doctors typically prescribe to manage seizure disorders, including epilepsy. These medications work in several ways. They change how ion channels within your cells work, which affects how ions go in and out of the cells.
These medications are typically very effective in treating nerve pain, but they may also cause undesired side effects, such as:
lethargy
blurred vision
vertigo
weight gain
swelling in the legs
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Some antidepressants may help treat nerve pain. The most effective antidepressant medications for neuropathy include serotonin–noradrenaline reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor).
Tricyclic antidepressants (TCAs) may also be prescribed and include amitriptyline (Elavil) and doxepin (Sinequan, Adapin).
Antidepressants can increase the number of neurotransmitters, which can reduce nerve pain by disrupting the pain signals sent to the brain.
However, antidepressants can cause side effects. These may vary depending on the medication you take.
SNRI side effects may include:
nausea and vomiting
abdominal pain
indigestion
loss of appetite
diarrhea
constipation
dizziness
agitation and anxiousness
fatigue
headache
TCA side effects may include:
constipation
dizziness
blurred vision
dry mouth
difficulties passing urine
drowsiness
weight gain
excessive sweating, in particular at night
heart palpitations
increased heartbeat (tachycardia)
irregular heartbeat (arrhythmia)
Not every antidepressant works the same way and has the same effects. While certain medications may quickly improve your nerve pain, others may be less effective. A 2018 study found that duloxetine is more effective in treating nerve damage caused by chemotherapy than venlafaxine.
Pain relief medications
Opioid medications alter how potassium and calcium ion channels work. This can help provide relief from nerve pain.
However, doctors typically consider opioids a second-line treatment option for people with nerve pain if antidepressants and anticonvulsants are not suitable or have not provided any improvement to their symptoms.
Pain relief medications for nerve pain may include drugs, such as:
These medications may cause side effects, including:
constipation
lethargy
nausea
vomiting
seizures
dizziness
breathing difficulties
When possible, doctors tend to avoid prescribing strong opioids for neuropathic pain as opioids can cause dependence and may cause people to develop opioid use disorder.
People should take opioids strictly following doctor’s recommendations.
Topical medications
Topical medications, such as ointments, patches, and creams, contain active components that can travel through your skin and into the body, improving nerve pain. Substances, such as lidocaine and capsaicin, can provide pain relief by numbing the parts of your body where they are applied.
An example includes the topical patch capsaicin transdermal (Qutenza).
Lidocaine and capsaicin act on sodium ion channels, reducing your discomfort, but they may cause side effects, including:
If nerve pain — such as peripheral neuropathy — is left untreated, it can lead to severe complications, such as gangrene.
Gangrene can occur if you have a wound that gets infected. It can lead to decreased blood supply in the body, which can cause tissue to die and, in some cases, lead to amputation.
As peripheral neuropathy can cause you to lose sensation in your limbs, you may have a wound and not be aware of it. This is why it is important to check your body for cuts and wounds to avoid infection.
How to choose the right medication for you
A doctor can advise you about the potential side effects and benefits of the treatment options for neuropathy that are suitable for your individual needs.
They can also address your concerns about the various treatment options and recommend the most appropriate nerve pain treatment depending on your symptoms and health conditions.
Summary
Several treatment options are available for treating nerve pain. The first-line treatment options for neuropathy typically include anticonvulsants and antidepressants. Topical treatments may also be effective in improving your symptoms.
Doctors may recommend using multiple treatments at once to provide you with a better pain management plan and reduce the risk of side effects.
Farshchian N, et al. (2018). Comparative study of the effects of venlafaxine and duloxetine on chemotherapy-induced peripheral neuropathy. https://pubmed.ncbi.nlm.nih.gov/30105459/
