Chronic Pain Treatment What Type of Nerve Pain Medication Is Right for Me? Prescription and over-the-counter nerve pain options By Erica Jacques Erica Jacques LinkedIn Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center. Learn about our editorial process Updated on March 08, 2022 Medically reviewed by Grant Hughes, MD Medically reviewed by Grant Hughes, MD LinkedIn Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Neuropathy Causes Adjuvant Analgesics Opioids Acetaminophen NSAIDs Topical Analgesics Frequently Asked Questions 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. 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.) Paul Bradbury / Caiaimage / Getty Images What Causes Neuropathy? This type of pain results from nerve damage. Damaged nerves become hyperexcitable and instead of merely processing pain signals, they will often start creating them. 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 Adjuvant Analgesics Analgesics are painkillers. 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. Only a few of these drugs are specifically approved for neuropathic pain treatment, so most are used off-label. Don’t let that worry you, though. Many adjuvant analgesics have proven more effective at treating chronic nerve pain symptoms than traditional painkillers. The two main classes used for treating neuropathic pain are anticonvulsants and antidepressants. 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 Food and Drug Administration (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 Depacon (valproate): Used off-label for diabetic neuropathy Side Effects and Warnings Risks and side effects vary by drug and can include drowsiness, dizziness, or suicidal thoughts. If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see our National Helpline Database. Side effects that are common with anticonvulsants are: FatigueNauseaDizzinessBlurred vision 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: Skin rashes Liver problems or failure Pancreas problems Low white blood cell count (leukopenia), putting you at risk of infection Low platelet count (thrombocytopenia), putting you at risk of excessive bleeding Don't Stop Without Medical Advice Don't stop taking anticonvulsants suddenly. You should only discontinue these medications on the advice of a healthcare provider. Be certain to get guidance on how to gradually taper your dosage so you can avoid unpleasant withdrawal symptoms such as altered mental status, agitation, excessive sweating, and seizures. Anticonvulsants for Chronic Pain Antidepressants Antidepressants are believed to treat chronic pain by altering the nervous system activity of certain neurotransmitters (chemical messengers), receptors, and pathways involved in processing pain and mood. Antidepressant categories used for neuropathy include: Tricyclics (TCAs)Selective serotonin reuptake inhibitors (SSRIs)Serotonin-norepinephrine reuptake inhibitors (SNRIs) As with anticonvulsants, you need to taper off of antidepressants rather than stopping them suddenly. Your healthcare provider can offer you guidance in the proper way to wean yourself off of these drugs. What You Need to Know: Antidepressant Withdrawal Warning: Suicide Risk All antidepressants are required to carry a black-box warning on their labels about an increased risk of suicidal thoughts and behaviors. Tricyclics 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 Aventyl/Pamelor (nortriptyline): Used off-label for postherpetic neuralgia and diabetic neuropathy Norpramin (desipramine): Used off-label for postherpetic neuralgia and diabetic neuropathy Tricyclic Side Effects While they vary by drug, general side effects of tricyclic antidepressants include: Blurry visionConstipationDizzinessDry mouthFatigueIncreased heart rateUrine retentionTremorWeight gain 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 are: Luvox (fluvoxamine): Used off-label for diabetic neuropathyProzac (fluoxetine): Used off-label for fibromyalgia and migraine SSRI Side Effects Side effects of SSRIs include: Agitation/anxietyDiarrheaDizzinessDry mouthExhaustionHeadacheInsomniaNauseaReduced libido or inability to orgasmTremors Check the packaging information that came with your prescription for the side effects of the specific drug you're taking. 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 A Note on Savella This drug is an SNRI and is marketed in many countries as an antidepressant. However, in the U.S. it is only approved for fibromyalgia, not for depression, so it isn't considered an antidepressant. SNRI Side Effects General side effects of SNRIs are: ConstipationDizzinessDry mouthExcessive sweatingHeadacheInsomniaNauseaReduced libido or inability to orgasm 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. 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 Ultram (tramadol) Morphine Vicodin (hydrocodone-acetaminophen) Percocet (oxycodone-acetaminophen) OxyContin (oxycodone) Methadone Opana (oxymorphone) Fentanyl Side Effects and Warnings Opioids are addictive. You should take the lowest effective dose for the shortest possible amount of time. The use of opioids for treating chronic pain is controversial. Common side effects of drugs in this class include: ConfusionConstipationDizzinessEuphoriaNausea and vomitingSleepiness Opioid Overdose Symptoms Signs of opioid overdose, which can be fatal, include:Loss of consciousnessExtremely small pupilsSlow and shallow breathingChoking or gurgling soundsGoing limpSkin that's pale, blue, or coldCall 911 immediately if you suspect someone is having an opioid overdose. Over time, you can build up a tolerance to opioids, meaning you'll need more of the drug to achieve the same level of pain control. This can put you at risk of addiction and fatal overdose. Acetaminophen Different from other painkillers, acetaminophen (the drug in Tylenol) 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). Side Effects and Warnings 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. Don't Double Up! Acetaminophen liver toxicity is a real threat when taking combination opioids. This can be due to taking increasingly larger doses due to opioid tolerance, or accidentally combining these drugs with one or more of the hundreds of over-the-counter (OTC) products that contain acetaminophen. Acetaminophen generally causes minimal side effects. The most common ones are: NauseaVomitingHeadache Tylenol Overdose: What You Need to Know NSAIDs Non-steroidal anti-inflammatory drugs are not very effective at treating neuropathic pain unless inflammation is contributing to symptoms. These common painkillers are available OTC and by prescription, and they're a common add-on to other drugs for treating breakthrough pain from neuropathy. Common OTC NSAIDs include: Advil/Motrin (ibuprofen) Aleve (naproxen) Aspirin (acetylsalicylic acid) Both ibuprofen and naproxen are also available in prescription strengths. Some NSAIDs that are only available by prescription are: Celebrex (celecoxib) Indocin (indomethacin) Lodine (etodolac) Mobic (meloxicam) Orudis (ketoprofen) Relafen (nabumetone) Toradol (ketorolac) Voltaren (diclofenac) Side Effects and Warnings 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 are: Stomach painConstipationDiarrheaGasHeartburnNauseaVomitingDizziness Less common side effects, which warrant immediate medical attention, include: Heart attackStrokeHigh blood pressureHeart failure related to fluid retentionKidney problems, including failureLiver problems, including failureBleeding intestinal and stomach ulcersAnemia (low red blood cells)Skin reactions, which can be life-threateningAllergic reactions, which can be life-threateningAsthma attacks (only in people with pre-existing asthma) Topical Analgesics 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 come 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. However, they're often associated with a lower risk of side effects because they're absorbed in smaller amounts that what you'd take in pill form and 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. Example: diclofenac. 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. Popular Topical Analgesics Lidocaine Lidocaine is one of the more commonly used topicals. It's available both OTC and by prescription and in creams, patches, and other forms. Lidocaine is FDA approved for postherpetic neuralgia and peripheral nerve block anesthesia and epidural anesthesia. It's used off-label for diabetic neuropathy. Lidocaine is available OTC in some Icy Hot and Aspercreme products and by prescription in multiple forms, including patches and films, gels and jellies, lotions, creams, and ointments. Some lidocaine-containing products are: Lidoderm PatchAnastia Topical LotionMentho-Caine/Solupak Topical Ointment The most common side effects of lidocaine include: Red spots on the skin (petechiae)ItchingNauseaVomitingDizzinessAgitation Pain Relief Patches: When to Consider Them Capsaicin Capsaicin, a popular OTC pain reliever, is FDA-approved for postherpetic neuralgia and diabetic neuropathy of the feet. It's available in multiple products and forms, including creams, lotions, and a film. Capsaicin-containing products include: Capzasin-P Topical CreamZostrix Topical CreamCastiva Warming Topical LotionQutenza Topical Film Common capsaicin side effects include: RashItchingNauseaInfectionVomitingHeadacheDry mouthCoughThroat irritationDizziness The burning sensation that makes capsaicin work may be too intense for some people to tolerate. Neuropathy Creams: Do They Work? Menthol You can find menthol in a wide variety of topical products including: Icy Hot Tiger Balm Biofreeze Bengay Aspercreme Heat Menthol is available as a cream, gel, liquid, powder, spray, foam, film, and pad. Side effects are uncommon with menthol. If you get it in your eyes, be sure to thoroughly rinse it out. Stop using the product and get medical attention if you experience: Severe burning, stinging, redness, or irritationPain, swelling, or blistering where it was appliedHives, difficulty breathing, or swelling of your face, lips, tongue, or throat To avoid burns, don't use menthol products with a heating pad. Warning: Topical Analgesics It is possible for topical analgesics to cause overdose and even death. Don't combine oral and topical forms of the same drug, don't use topical products over large portions of your body, and don't cover topical analgesics with a bandage or plastic wrap unless directed to do so by a healthcare provider. These things can all cause your body to absorb too much of the drug. An Overview of Lidocaine Overdose 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. Frequently Asked Questions How can I treat nerve pain at home? You can treat nerve pain at home with OTC medications and topical analgesics. You may also find that rest, stress reduction, and other lifestyle changes help.Most people with neuropathic pain require help from a healthcare provider or medical team to make significant improvements. Involve your healthcare provider in any self-treatment decisions and lifestyle modifications. What do neurologist prescribe for nerve pain? Neuropathic pain is commonly treated with drugs known as adjuvant analgesics. These are typically antidepressants and anticonvulsants prescribed for off-label use. Medications often prescribed for nerve pain include: AmitriptylineCymbaltaDepaconGabapentinLyricaProzacTegretolVenlafaxine Do opioid painkillers work on nerve pain? Yes, but not without risks. Opioids like codeine, tramadol, and oxycodone block pain signals that the body sends to the brain. As a result, you don’t feel the pain. However, opioids also come with negative side effects and a high risk of addiction. They are considered the last line of treatment for neuropathic pain and should only be used for short time periods. Long-term opioid use leads to physical dependence. Stopping opioids abruptly can lead to painful withdrawal symptoms and sickness. 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Icy Hot pain relieving stick-menthol and methyl salicylate stick; Icy Hot pain relieving balm-menthol and methyl salicylate ointment; Icy Hot pain relieving cream-menthol and methyl salicylate cream. National Institutes of Health, U.S. National Library of Medicine: DailyMed. Label: Icy Hot with Lidocaine pain relieving-lidocaine hcl and menthol cream. Prescribers' Digital Reference. Lidocaine - Drug summary. Prescribers' Digital Reference. Capsaicin - Drug summary. University of Michigan, Michigan Medicine. Capsaicin, lidocaine, mentho, and methyl salicylate (topical). U.S. Food and Drug Administration. Topical pain relievers may cause burns. By Erica Jacques Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit