Types, how they work, side effects

Nerve pain, also called neuropathic pain or neuropathy, refers to painful sensations around nerves. A variety of treatment options are available, including anticonvulsants, some antidepressants, mild opioids, and some topical treatments.

Scientists define nerve pain or neuropathy as any condition in which an individual has suffered nerve damage.

This article reviews the main types of medication for neuropathy, discussing which ones have the most positive effects. It also considers what science has to say about non-pharmacological treatments for this condition.

Anticonvulsants are first-line medications that help manage the symptoms of seizure disorders, such as epilepsy.

Like a 2022 review explains, these drugs can work in different ways. An important mechanism of action involves ion channels, which are cellular components that regulate cellular function by letting mineral ions in and out.

A paper 2017 suggests that certain anticonvulsants are among the most effective drugs for neuropathic pain. These first-line drugs for neuropathy act on specific ion channels that transport calcium ions. They include gabapentin (Neurontin) and pregabalin (Lyrica).

Although often effective, these medications can cause side effects.

A 2019 review lists the following possible side effects of gabapentin and pregabalin:

Gabapentin can also cause blurred vision, while pregabalin can cause weight gain.

A person should see a doctor if they notice these symptoms after taking anticonvulsants.

Scientists also consider certain antidepressants as first-line treatment for neuropathic pain. The most effective antidepressants for neuropathic pain are tricyclic antidepressants (TCAs) and serotonin norepinephrine reuptake inhibitors (SNRIs).

However, these drugs can also produce Side effects.

Amitriptyline

Amitriptyline is an ATC that can help people manage nerve pain. However, this can lead to a host of adverse effects, including:

In rare cases, some people may have serious side effects after taking amitriptyline. These may include:

Duloxetine and venlafaxine

Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor). A study 2018 demonstrated that duloxetine was more effective than venlafaxine in reducing symptoms of chemotherapy-induced peripheral neuropathy.

However, these drugs can cause side effects.

Duloxetine can cause:

  • constipation
  • dry mouth
  • difficulties with:
    • balance
    • while walking
    • Speaking
    • swallow

Possible side effects of venlafaxine include:

People should talk to a doctor if they experience side effects that affect their quality of life.

experts consider certain opioids as a second-line treatment option. A 2022 review notes that opioids act on calcium and potassium ion channels to produce painkilling effects.

Tramadol (Ultram) and tapentadol (Nucynta) are opioids that can relieve neuropathic pain. However, there is some evidence that both drugs can cause side effects, some of which are serious. These include:

Doctors are less likely to prescribe stronger opioids for neuropathic pain. Stronger opioids for neuropathy include morphine and oxycodone, which cause side effects similar to those above.

Morphine can also cause dizziness, while oxycodone can induce breathing difficulties. There is also a risk of tolerance, dependence or misuse, which can lead to opioid use disorder.

A person should seek immediate medical attention if these medications affect their breathing or cause serious side effects. It is also important to follow the prescription carefully.

Topical treatments are creams, ointments, or patches that individuals can place on their skin. The active components of these products must travel through the skin and into the body, where they will affect the nerves.

The options to understand lidocaine — a type of local anesthetic — and capsaicin patches.

Lidocaine relieves pain by acting on sodium ion channels. However, lidocaine patches can cause rash, erythema, and itching.

To research also showed that capsaicin, naturally present in peppers, acts on both calcium and sodium ion channels. As with lidocaine, capsaicin patches may cause erythema and itching. In rare cases, they can also cause pain and high blood pressure.

Discover the best capsaicin creams.

In some cases of neuropathic pain, doctors may recommend that a person take several medications at once. However, the evidence for the effectiveness of combination therapy is inconclusive.

A study 2017 suggests that certain drug combinations might be helpful. For example, taking an anticonvulsant, such as gabapentin or pregabalin, in addition to an TCA antidepressant might be more effective than taking either type of medication alone.

The combination of different drugs can sometimes improve pain relief and tolerance.

However, sufficient evidence has not yet emerged to confirm that combination therapy is more effective than monotherapies.

Despite medical advances, pharmacological treatments for neuropathic pain are only effective in less than 50% of cases. Therefore, many people seek alternative sources of treatment for this condition.

There is limited evidence that non-pharmaceutical products are helpful in this regard.

However, a overview of recent treatment suggests that spinal cord stimulation (SCS) therapy may relieve nerve pain in cases where pharmaceutical treatments have proven ineffective. SCS therapy involves stimulating a person’s spinal cord with electrical impulses. Doctors do this by inserting small electrodes into the spine, using either surgery or an epidural needle.

Doctors may prescribe a variety of medical treatments for nerve pain, including antidepressants, anticonvulsants, opioids, and topical medications.

In some cases, they may recommend several treatments at once. However, existing research has not determined whether it is more effective than a single treatment.

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