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Chronic Nerve Pain Treatment

Common Approaches to Chronic Nerve Pain Treatment

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Updated June 08, 2014

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Treating chronic nerve pain can be a challenge, as the cause is not always understood. Traditional painkillers used alone, such as NSAIDs, are often ineffective at treating this type of pain; however, a multimodal treatment approach can keep nerve pain symptoms under better control. This approach includes both traditional painkillers, nontraditional pain medications and other related pain treatments.

Neuropathic Pain Treatment – Adjuvant Analgesics

Adjuvant analgesics, such as anticonvulsants and antidepressants, can often combat neuropathic pain sensations. Because these medications were designed to treat conditions other than pain, their use in neuropathic pain treatment is termed "off-label" use. But don’t let that worry you: many adjuvant analgesics have proven more effective at treating chronic nerve pain symptoms than traditional painkillers.

Anticonvulsants used for nerve pain treatment:

  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Carbamazepine (Tegretol)
  • Oxcarbazepine (Trileptal)
  • Phenytoin (Dilantin)
  • Valproate (Depacon)
  • Lamotrigine (Lamictol)

Antidepressants used for nerve pain treatment:

  • Amitriptyline (Elavil)
  • Nortriptyline (Aventyl)
  • Desipramine (Norpramin)
  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)

More on the use of adjuvant analgesics for chronic pain treatment:

Neuropathic Pain Treatment – Traditional Painkillers

In many cases, traditional painkillers alone are not able to control chronic nerve pain symptoms completely. This is because many traditional painkillers, such as NSAIDs, target inflammation, which may or may not be the cause of nerve pain. However, some traditional painkillers do have a role in the treatment of chronic nerve pain. They may be used when adjuvant analgesics are not effective, or in combination with anticonvulsants or antidepressants.

  • NSAIDs. NSAIDs alone may not be effective at treating neuropathic pain; however, for some people, swelling makes nerve pain symptoms worse. NSAIDs, such as ibuprofen (Advil) or naproxen (Aleve), may be combined with other pain treatments, and may help control breakthrough pain.
  • Acetaminophen. Acetaminophen (Tyleonl) may be used in combination with adjuvant analgesics to control neuropathic pain, or may be used for episodes of breakthrough pain. Some opioids used for neuropathic pain treatment also contain acetaminophen.
  • Opioids. Opioids may be prescribed for severe neuropthic pain treatment, or as a last line of defense when adjuvant analgesics fail to relieve pain. A "weak" opioid commonly prescribed for neuropathic pain is tramadol (Ultram); however, stronger opioids may also be necessary.
  • Topical Analgesics. While not always effective, some people with neuropathic pain find relief with external pain medications, including lidocaine and capsacin. Topical analgesics may be combined with other medications.

Neuropathic Pain Treatment – Other Options

Medications are not the only answer when it comes to neuropathic pain treatment. Some other options that may be used alone, or in combination with painkillers, include:

Complimentary and alternative medicine (CAM) may also be helpful for neuropathic pain treatment, including acupuncture as well as herbal remedies. Though most CAMs do not require a prescription, you should still talk to your doctor before starting any new treatments for your nerve pain.

For more information on using CAMs to treat chronic pain, see Should I Try Alternative Medicine?

Sources:

National Guideline Clearinghouse. EFNS Guidelines on Pharmacological Treatment of Neuropathic Pain. Accessed 2/16/10. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10472&nbr=5495

National Pain Foundation. Neuropathic Pain: Medications. Accessed 2/17/10. http://www.nationalpainfoundation.org/articles/357/medications?PHPSESSID=cb06bd3dadba07ef310243bada87c449

The Merck Manuals Online Medical Library. Neuropathic Pain. Accessed 2/16/10. http://www.merck.com/mmpe/sec16/ch209/ch209c.html

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