What Type of Nerve Pain Medication Is Right for Me?

When you have neuropathy, pain is usually best managed with a multimodal treatment approach that incorporates different types of treatment instead of relying on just one. Treatments can include traditional painkillers, nontraditional pain medications, and other related pain treatments.

Traditional painkillers used alone, especially non-steroidal anti-inflammatory drugs (NSAIDs), are often ineffective at treating neuropathic pain.

The right combination of pain management strategies will help you function better and have a better quality of life. Treatments vary from person to person—it all depends on your pain and your needs.

What Is Neuropathy?

Neuropathy is disease or dysfunction in the nerves that can cause pain and other abnormal sensations, such as tingling, shooting, "zinging," numbness, and weakness. Damaged nerves become hyperexcitable, or overly active, and instead of merely processing pain signals, they will often start creating them.

Pain from neuropathy is called neuropathic pain. While it can strike nerves of the central nervous system (brain and spinal cord), it's more common in the peripheral nerves (those outside the central nervous system.)

Conditions involving neuropathic pain include:

• Diabetic neuropathy
• Trigeminal neuralgia
• Migraine
• Myofascial pain
• Fibromyalgia
• Post-herpetic neuralgia
• Radiculopathy
• Central pain syndrome

Other conditions and factors that sometimes can lead to neuropathic pain include:

• Cancer
• Chemotherapy
• Stroke (post-stroke central pain)
• HIV and other infections
• Injury
• Amputation

Over-the-Counter Options

There are a few over-the-counter (OTC) medications that may help ease neuropathic pain. Unless your pain is severe, it is a good idea to try these medications first before asking your healthcare provider for prescription options.

Patches and Creams

Some people with neuropathic pain find relief with topical pain medications, which are applied to the skin in the form of creams, gels, and patches and are available OTC or by prescription. A real benefit of topical analgesics is that they work directly on the site of your pain and can be safely combined with other medications.

Topical medications are absorbed through your skin and enter the bloodstream. They're often associated with a lower risk of side effects because they're absorbed in smaller amounts than what you'd take in pill form. They don't travel through your digestive system, where some painkillers can cause damage.

Different types of local analgesics work in different ways, and some are better than others for treating nerve pain.

• Local anesthetics: These temporarily numb the nerves so they no longer send pain signals, and they work well for many people with neuropathic pain. Examples include lidocaine, benzocaine, tetracaine, and bupivanor.
• Counter-irritants: These cause new sensations that briefly distract your nerves from sending pain signals, and they are often good at reducing neuropathic pain. Sensations may be cold, hot, or tingling. Examples are capsaicin and methyl salicylate.
• Topical NSAIDs: These reduce inflammation when absorbed through the skin and are less likely to work for nerve pain unless it is due to inflammation. Diclofenac is one example.
• Menthol products: These cause a cooling sensation that temporarily desensitizes your nerve endings and decreases blood flow (like an ice pack would), which may work better for inflammation-related pain than nerve pain. Look for menthol on the label.

Many topical products combine two or more of these ingredients. For example, Icy Hot contains both methyl salicylate and menthol, while Icy Hot with Lidocaine contains lidocaine and menthol.

Oral Pain Relievers

Oral pain relievers can be purchased over the counter. There are two main types: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

• NSAIDS are not very effective at treating neuropathic pain unless inflammation is contributing to symptoms. These painkillers are a common add-on to other drugs for treating breakthrough pain from neuropathy. Common options include Advil/Motrin (ibuprofen), Aleve (naproxen), and Aspirin (acetylsalicylic acid).
• Tylenol (acetaminophen) is different from other painkillers. It works by increasing your pain threshold, which is the point at which a sensation registers as painful. Acetaminophen is commonly used alongside other pain relievers because it doesn't interact negatively with them. That makes it a common go-to for breakthrough pain (pain that persists despite treatment).
  

Supplements

Some people take supplements to help control neuropathic pain, but the research into the effectiveness of these is limited. Supplements may also interact with other drugs you are taking, so make sure to discuss the use of these supplements with your healthcare provider.

• Vitamin B: Vitamins B1, B6, and B12 can help support a healthy nervous system. Some people have neuropathic pain that is related to a B12 deficiency, so it may help to take a supplement or eat foods rich in B vitamins, such as meat, poultry, fish, eggs, and low-fat dairy products.
• Alpha-lipoic acid is an antioxidant. Some people take it to relieve neuropathic pain, tingling, and numbness. You can also get this antioxidant from certain foods such as red meat, broccoli, Brussels sprouts, and spinach.

Some other supplements commonly used to treat neuropathic pain include:

• Fish oil: This oil, which works as an anti-inflammatory and may help to restore nerve damage, can be taken as a supplement or found in foods such as salmon, mackerel, oysters, anchovies, or sardines.
• Curcumin: The main active ingredient in turmeric, curcumin is an anti-inflammatory and antioxidant.
• Acetyl-L-carnitine: This is an amino acid the body produces naturally, and it's also taken to relieve neuropathic pain.
• N-acetyl cysteine: The synthetic form of the amino acid cysteine, this supplement may fight free radicals, which can cause inflammation.
  

Prescription Medication

Analgesics are painkillers. Topical therapies approved by the Food and Drug Administration (FDA) to treat diabetic neuropathy include medications such as Qutenza (capsaicin).

Adjuvant analgesics are drugs created to treat other conditions that also happen to have an impact on some types of pain. Anticonvulsants and antidepressants, through their effects on the nervous system, can often combat neuropathic pain sensations.

Other prescription options include prescription-strength NSAIDs and opioids.

Anticonvulsants

Also called anti-seizure or anti-epileptic drugs, anticonvulsants calm hyperexcited nerves and have long been used to treat painful neuropathy. Epilepsy and neuropathic pain actually share certain molecular changes that are involved in nerve hyperexcitability, which may help explain why these drugs are effective against both conditions.

Not all drugs in this class work the same way, and some work better than others for treating specific conditions. Some are approved by the FDA for treating pain, while others are used off-label.

Anticonvulsants commonly prescribed for treating nerve pain include:

• Neurontin (gabapentin): FDA approved for post-herpetic neuralgia, used off-label for fibromyalgia, diabetic neuropathy, and other neuropathic pain
• Lyrica (pregabalin): FDA approved for post-herpetic neuralgia, diabetic neuropathy, fibromyalgia, pain from spinal cord injury, and central neuropathic pain
• Tegretol (carbamazepine): FDA approved for trigeminal neuralgia; used off-label for diabetic neuropathy and postherpetic neuralgia
• Trileptal (oxcarbazepine): Used off-label for trigeminal neuralgia and other neuropathic pain
• Valproate: Used off-label for diabetic neuropathy

Tricyclic Antidepressants

Tricyclic antidepressants work by increasing the amount of the neurotransmitters serotonin and norepinephrine available to your brain by slowing a recycling process called reuptake. They also block receptors for other neurotransmitters—including acetylcholine and histamine—which makes them unable to send signals via brain cells.

For some people, these drugs can improve the balance of neurotransmitters and improve the way the brain functions. This can have effects on both mood and pain.

Tricyclics used for treating nerve pain include:

• Amitriptyline: Used off-label for diabetic neuropathy, postherpetic neuralgia, migraine, and fibromyalgia
• Pamelor (nortriptyline): Used off-label for postherpetic neuralgia and diabetic neuropathy
• Norpramin (desipramine): Used off-label for postherpetic neuralgia and diabetic neuropathy

SNRIs

Serotonin-norepinephrine reuptake inhibitors slow the reuptake of both of these neurotransmitters. This class includes the only antidepressants to receive FDA approval for pain.

• Cymbalta (duloxetine): FDA approved for fibromyalgia and diabetic neuropathy
• Savella (milnacipran): FDA approved for fibromyalgia
• Venlafaxine: Used off-label for fibromyalgia, diabetic neuropathy, and migraine

SSRIs

Selective serotonin reuptake inhibitors specifically slow the reuptake of serotonin, leaving more serotonin available for use. This is believed to help in neuropathy because serotonin plays a key role in pain signals.

SSRIs generally cause fewer unpleasant side effects than tricyclics. However, studies suggest they have relatively small effects on neuropathic pain, so they're not used as often as tricyclics and SNRIs.

SSRIs that are sometimes used for nerve pain include:

• Luvox (fluvoxamine): Used off-label for diabetic neuropathy
• Prozac (fluoxetine): Used off-label for fibromyalgia and migraine
  

NSAIDs

Both ibuprofen and naproxen are also available in prescription strengths.

Some NSAIDs that are only available by prescription include:

• Celebrex (celecoxib)
• Indocin (indomethacin)
• Etodolac
• Mobic (meloxicam)
• Ketoprofen
• Nabumetone
• Ketorolac
• Voltaren (diclofenac)

Opioids

Opioids, also called opiates or narcotics, are powerful prescription painkillers. They're also addictive and classified as controlled substances. Because of an epidemic of recreational opioid abuse and potentially deadly overdose, many healthcare providers limit the use of opioids and require pain contracts, pill counts, and other measures meant to prevent addiction and abuse.

Opioids work by blocking pain signals that the body sends to the brain, so the brain doesn't receive the signals or perceive the pain. They're commonly used for managing pain from severe injuries, cancer pain, and post-surgical pain.

When it comes to neuropathic pain, opioids are generally considered a last line of treatment and prescribed only when all adjuvant painkillers fail.

Opioids include:

• Codeine
• Tramadol
• Morphine
• Hydrocodone-acetaminophen
• Percocet (oxycodone-acetaminophen)
• OxyContin (oxycodone)
• Methadone
• Oxymorphone
• Fentanyl

Side Effects

All medications can have side effects, even OTC medications. If you experience any side effects while using these medications, it's important to discuss them with your healthcare provider. You may need to alter your dose or switch to a different medication.

OTC Side Effects

OTC medication can cause side effects. Some of these include:

• Acetaminophen usually has minimal side effects. If side effects do occur, they may include nausea, vomiting, and headache.
• NSAIDs can be hard on your liver, kidneys, and stomach/intestines. Your healthcare provider may monitor for these problems if you're on an NSAID long-term. Common side effects of NSAIDs may include stomach pain, diarrhea or constipation, gas, heartburn, and nausea/vomiting. Less common side effects include heart attack, stroke, kidney and liver problems, and gastrointestinal bleeding.
• Lidocaine can cause side effects such as red spots on the skin, itching, nausea/vomiting, dizziness, and agitation.

Prescription Side Effects

Prescription medication can have various side effects, depending on the drug you're taking and how much of it you take. Be sure to discuss these side effects and any others that aren't listed with your healthcare provider.

• Opioid/acetaminophen combinations: Some opioids, including Vicodin and Percocet, are combination drugs, meaning the narcotic medication is combined with acetaminophen. Many OTC drug formulations contain acetaminophen as well, including a lot of cold and flu remedies. Taking too much acetaminophen can lead to liver toxicity, which can be fatal. If you take a combination opioid, check the labels of everything else you take to make sure you don't get too much acetaminophen. When increasing your dosage, talk to your healthcare provider about whether a combination drug is still the best option for you.
• Anticonvulsants: Risks and side effects vary by drug and can include drowsiness, dizziness, fatigue, and nausea. These effects are generally tolerable and tend to taper off over a few weeks or months. Less common and more serious side effects may include liver and pancreas problems, low white blood cell or platelet count, and suicidal thoughts.

• Opioids: Common opioid side effects include confusion, constipation, dizziness, nausea and vomiting, sleepiness, and euphoria.
  

• Tricyclic Antidepressants: While they vary by drug, general side effects of tricyclic antidepressants include blurry vision, constipation, dizziness, tremor, dry mouth, fatigue, increased heart rate, urine retention, and weight gain.
• SSRIs: Side effects of SSRIs include agitation and anxiety, dizziness, dry mouth, fatigue, headache, insomnia, nausea/diarrhea, tremors, and reduced libido. Check the packaging information that came with your prescription for the side effects of the specific drug you're taking.
• SNRIs: General side effects of SNRIs include nausea, constipation, dizziness, dry mouth, sweating, headache, insomnia, and reduced libido. Because side effects are somewhat different for each drug, be sure you're familiar with the full list of side effects for the one you're prescribed.
  

Other Treatment Options

Other treatment options are available for neuropathic pain, including:

• Physical therapy: Therapists work to improve muscle strength and reduce pain through a variety of techniques, such as stretching and range of motion exercises.
• Transcutaneous electrical nerve stimulation (TENS): This involves delivering a low-voltage electrical current at or near the location of your pain, possibly altering your perception of the pain.
• Plasma exchange and intravenous immune globulin: In plasma exchange, plasma is removed from your blood, replaced with fresh plasma, and returned to the body. Intravenous immune globulin involves delivering antibodies through an IV.
• Surgery: This typically involves one or two surgical incisions to decompress nerves in the extremities.
  

Summary

Nerve pain can be treated with both OTC and prescription medications. Some of the options include topical medications, painkillers like NSAIDs, and prescription medications like anticonvulsants, antidepressants, and opioids. 

All medications have a risk of side effects. Make sure you understand the potential side effects you might experience with the medication you are taking and report them to your healthcare provider. You can work with your healthcare provider to adjust your medications and dose until you find one that works for you and has tolerable side effects.

A Word From Verywell

It's common to end up taking more than one medication to treat nerve pain, and that can potentially lead to harmful drug interactions. Be sure to check with your healthcare provider and pharmacist before adding any over-the-counter drugs, supplements, or herbal products to your treatment regimen. It's also a good idea to have your pharmacist review your medications anytime you're prescribed something new.