Medications Available to Treat Chronic Nerve Pain

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.

Adjuvant Analgesics for Chronic Nerve Pain

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 (Lamictal)

Antidepressants used for nerve pain treatment:

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

Traditional Painkillers for Neuropathic Pain Treatment

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 (Tylenol) 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 neuropathic 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 externally applied pain medications, including lidocaine and capsaicin. Topical analgesics may be combined with other medications.

Other Options for Neuropathic Pain Treatment

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:

• Physical therapy
• Nerve blocks
• Spinal cord stimulation
• Nerve decompression surgery

Complementary 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.

_Sources

_{National Guideline Clearinghouse. EFNS Guidelines on Pharmacological Treatment of Neuropathic Pain.}

_{National Pain Foundation. Neuropathic Pain: Medications.}

_{The Merck Manuals Online Medical Library. Neuropathic Pain.}