Jensen, T. The Lancet, Oct. 10, 2009.
Drugs that relieve nerve pain
When chronic pain comes from the nerves, these nerve pain medications can help when added to other pain relievers.
For chronic muscle and joint pain, effective therapies include rest, ice and heat, anti-inflammatory medications, and time. Usually, the pain calms down and you feel better.
However, muscle and joints may be only part of the picture. For instance, pain can be coming primarily from irritated nerves, along with the injured and inflamed muscle or joint.
Often the discomfort is only arising from nerve pain. Typical signs of this “neuropathic” pain include sharp, stinging pain or pain that radiates from one part of the body to adjacent areas. One of the most common causes is diabetes, although it can also be brought on by injury, infection, and some medications.
“People say things like, ‘My knee hurts and I feel like it’s coming up to the middle of my thigh and down to my shin,” says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. “In those cases, the nerve may be involved.”
In neuropathic pain, the nerve that was the mere messenger of pain now becomes the actual source. Narcotic pain relievers don’t often help and even when they do, they should not be used as a long term solution. Fortunately there are other options. Certain drugs that were originally developed to treat depression and seizure disorders also damp down inappropriate or excessive pain signaling in the nerves.
Nerve pain medications
A variety of drugs can be added to conventional pain relievers to reduce nerve pain. Adding one of these nerve pain medications won’t completely take the pain away, but it may help.
Anticonvulsants: These medications were developed to control seizures, but they also help to blunt pain signals in the nerves. Several are in wide use for chronic pain (see “Medications for nerve pain”).
It takes about three to four weeks for the full effect to kick in. Your doctor will usually start you on a low dose and gradually increase it. That reduces side effects.
Antidepressants: Certain types of antidepressants also help to control nerve pain. They may have a synergistic effect in people who experience depression along with chronic pain. Chronic pain often causes depression, and depression can intensify a person’s sensitivity to pain; some antidepressants address both. There are three options:
- Tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor). These drugs are prescribed for pain at doses lower than are effective for depression.
- Serotonin–norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor). SNRIs have fewer side effects than tricyclics, although some research suggests they may be less effective.
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), are the most commonly prescribed medications for depression. Some doctors may try these for treating nerve pain, too, but the evidence for effective pain relief is mixed.
Types of pain: Nociceptive vs. neuropathic
- Nociceptive (body)pain comes from damaged tissues outside the nervous system, such as muscles and joints. People say the pain feels aching and throbbing.
- Neuropathic (nerve)pain comes from the nerves that transmit pain signals from the body to the brain. People describe the pain as burning, stinging, or shooting. It may radiate from one area of the body to another. It may be accompanied by numbness and tingling.
Doctors usually try one type or the other (antidepressants or anticonvulsants), although they can be combined. They are taken daily in addition to conventional pain relievers.
Prescription Medications and Treatments for Nerve Pain
Getting control of your nerve pain can be tough. The good news is that doctors have a lot of effective ways to treat it. These include medicines, like prescription pain relievers or anticonvulsants and antidepressants, as well as electrical stimulation and other techniques.
So if you have nerve pain, whether it’s caused by cancer, HIV, shingles, or another condition, take hope. Here’s a rundown of the prescription treatments that your doctor might recommend.
Prescription Medicines for Nerve Pain
There are several types of medication that help with nerve pain. However, not all of the ones listed here will necessarily work for your specific type of pain. The best choice for you depends on the cause of your pain, the severity, the potential side effects, and other factors.
- Anticonvulsants. The name might sound alarming, but some of these drugs can help people with nerve pain. In fact, they’re often considered a first choice. These drugs were originally developed for people with epilepsy to control seizures. It turned out that their effects on the nervous system could also help dull pain. Side effects may include drowsiness, dizziness, and nausea.
Keep in mind that not all anticonvulsants will help. So your doctor will choose medicines that have been shown in studies to work on nerve pain.
- Antidepressants. Along with anticonvulsants, certain types of antidepressants can be the first choice for treating neuropathic pain. Nerve pain specialists often recommend two major types.
- Tricyclic antidepressants have been used for decades. While they’re not used as often today to treat depression, they can play an important role in controlling nerve pain symptoms. Many studies have shown that they can help. These drugs can cause side effects, like dizziness, constipation, blurred vision, and upset stomach. They might not be safe for people with certain conditions, like heart problems.
- SNRIs (serotonin and norepinephrine reuptake inhibitors) are a newer type of antidepressant that seem to help with nerve pain. In general, these drugs have fewer side effects than tricyclic antidepressants. They might be safer for some, especially older people with heart problems. However, they might not be as effective as tricyclics in tackling nerve pain.
Using antidepressants for nerve pain can have an added benefit, considering that chronic pain often coincides with depression. Chronic pain can make a person depressed, and depression can often make the experience of chronic pain seem worse. So these drugs might help improve your mood, as well as ease your discomfort.
Of course, some people don’t like the idea of taking antidepressants for their nerve pain because they worry taking antidepressants implies that the pain is just “in their heads.” But that’s not the case at all. It just happens that these drugs work with both conditions.
- Painkillers. For severe nerve pain, powerful opioid painkillers can help. Studies have found that for many types of nerve pain, they are as effective as anticonvulsants or antidepressants. Unlike other treatments for nerve pain, they also work very quickly.
However, because of their side effects, many doctors only turn to these drugs when other treatments haven’t worked. Opioid painkillers can cause constipation, stomach upset, and sedation. They also pose some risk of addiction and abuse, so it’s important to use them exactly as your doctor recommends.
Other painkillers — like prescription doses of NSAIDs (nonsteroidal anti-inflammatory drugs) — might be helpful. But on the whole, those drugs don’t seem to work well with nerve pain. - Topical treatments. Painkilling gels and lidocaine patches are another effective approach; you would apply them on a particularly painful area of skin. These work best with small, localized spots of pain. The side effects are minor and include skin irritation.
- Combination treatments. Your doctor might recommend that you use one or two of these treatments together — an approach called combination therapy. Many studies have shown that combining certain drugs — often an anticonvulsant and an antidepressant — has a better effect on nerve pain than either medications alone.
Three Tips for Taking Nerve Pain Medication
- Watch out for interactions. Before you start taking a new medicine, make sure your doctor knows about every other prescription drug, OTC medicine, supplement, and vitamin you use. You might want to write them all down and bring in the list to your appointment — or even bring the pill bottles with you instead.
- Always follow your doctor’s instructions for taking a new medicine. Make sure you understand how often you take it, how much you take, what time of day you should take it, and whether you should take it with or without food. Never stop using a prescription medicine without talking to your doctor first.
- Don’t ignore side effects. Talk to your doctor about them. They might be able to alter the dose or change the medicine to resolve the problem.
Other Treatments for Nerve Pain
While medications are typically the first choice for neuropathic pain, some other approaches might help too. Here are some nondrug options.
Electrical stimulation. When you feel nerve pain, an electrical signal is being sent from a damaged nerve to your brain. Some treatments for nerve pain work by sending out their own electrical impulses. These charges seem to interrupt or block the pain signals, reducing the pain you feel.
- TENS (transcutaneous electrical nerve stimulation) is one example of this approach. A small device sends a mild electric current through your skin. While TENS is simple and painless, the evidence that it helps with nerve pain is mixed. However, recent studies do seem to show that it can help with diabetic nerve pain, so the American Academy of Neurology does recommend it.
- PENS (percutaneous electrical nerve stimulation ) — also called electroacupuncture — delivers electrical stimulation to the nerves through acupuncture needles. The American Academy of Neurology deems this probably effective in treating diabetic nerve pain, but the treatment is not widely available.
- rTMS (repetitive transcranial magnetic stimulation) uses magnets to send electrical impulses into the brain. While evidence is limited, studies suggest that PENS and rTMS may help with nerve pain.
Other methods of electrical stimulation are more complex and require surgery. For instance, spinal cord stimulation involves implanting a device in the body that sends out electrical impulses to the spinal cord. For deep brain stimulation (DBS), a surgeon would implant electrodes in the brain. Generally, doctors only use these invasive approaches when everything else has failed.
Controlling Nerve Pain
Nerve pain can be hard to control. Some studies suggest that many people with nerve pain are not getting sufficient pain relief.
However, that doesn’t mean you have to accept a life in pain. Experts believe that many of those people in pain could be helped. It’s just that they aren’t getting the proper treatment. They might be relying on medications that don’t work. Or they might be getting the right drugs at the wrong dose.
So, if you’re suffering with nerve pain and treatment isn’t helping enough, don’t give up hope. Instead, go back to your doctor and come up with a new approach. Or get a referral to an expert — like a pain specialist or a neurologist.
There are a lot of different ways to tackle nerve pain. If one approach doesn’t work, others might. By working with an expert, and being persistent, you can find something that will help.
Show Sources
Cruccu, G. European Journal of Neurology, 2007.
Dworkin, R. American Journal of Medicine, October 2009.
Freynhagen, R. BMJ, August 2009.
Gilron, I. The Lancet, Oct. 10, 2009.
Jann, M. Pharmacotherapy, 2007.
Jensen, T. The Lancet, Oct. 10, 2009.
National Institute of Neurologic Disorders and Stroke web site: “Peripheral Neuropathy Fact Sheet.”
National Pain Foundation web site: “Neuropathic Pain: Medications,” “Neuropathic Pain: Injections,” “Neuropathic Pain: Surgery.”
O’Connor, A. American Journal of Medicine, October 2009.
Dubinsky, RM, Neurology, January 2010.
Leung, A. J. Pain, Dec 2009.
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