Neuropathic Pain Management and Medications

Given the intense nature of neuropathic pain, medications are frequently a first line of treatment. However, finding an effective medication takes a trial and error approach and can at times be frustrating to both the patient and the doctor. In addition, the side effects of many medications can be problematic.

Types of Medications for Neuropathic Pain

The three types of medications most commonly prescribed for nerve pain include:

  • Antidepressants or tricyclic antidepressants (TCA’s), such as Amitriptyline and Nortriptiline. The newer selective serotonin reuptake inhibitors (SSRI) antidepressant medications (such as Prozac) are not considered as effective for this condition as tricyclic antidepressants.
  • Anticonvulsants (also called neuroleptic medications) such as carbamazepine, felbamate, valproic acid, clonazepam, and phenytoin. A newer drug, gabapentin (Neurontin), is also considered effective and is generally well tolerated by most patients
  • Local anesthetics, such as intravenous application of lidocaine, tocainide or mexiletine can often provide relief

Antidepressants (TCA's) and anticonvulsants are typically the first line of treatment, and the combination of the two medications is thought to be particularly effective. Frequently, a combination of antidepressants, anticonvulsants and local anesthetics may be prescribed.

Additionally, topical capsaicin (pepper creams) can be applied to the skin for pain relief, although it may take multiple daily applications for several weeks before it is effective.

Generally, most studies have shown that opioid analgesics (such as morphine) and NSAIDs (such as ibuprofen, Cox-2 inhibitors) are not effective in alleviating most types of neuropathic pain. However, for different patients and different forms of neuropathic pain, these medications may be of value. Relatively high doses of opioids may be required to be effective.

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