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Treatments and drugs
By Mayo Clinic staffOne goal of treatment is to manage the condition causing your neuropathy. If the underlying cause is corrected, the neuropathy often improves on its own. Another goal of treatment is to relieve the painful symptoms.
Medications
Many types of medications can be used to relieve the pain of peripheral neuropathy, including:
- Pain relievers. Mild symptoms may be relieved by over-the-counter pain medications. For more-severe symptoms, your doctor may recommend prescription painkillers. Drugs containing opiates, such as codeine, can lead to dependence, constipation or sedation, so these drugs are generally prescribed only when other treatments fail.
- Anti-seizure medications. Drugs such as gabapentin (Gralise, Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Carbatrol, Tegretol) and phenytoin (Dilantin, Phenytek) were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects may include drowsiness and dizziness.
- Capsaicin. A cream containing this naturally occurring substance found in hot peppers can cause modest improvements in peripheral neuropathy symptoms. Like spicy foods, it may take some time and gradual exposure to get used to because of the hot sensation this cream creates. Generally, you have to get used to the heat before you can experience pain relief. Doctors may suggest you use this cream with other treatments.
- Lidocaine patch. This patch contains the topical anesthetic lidocaine. You apply it to the area where your pain is most severe, and you can use up to four patches a day to relieve pain. This treatment has almost no side effects except, for some people, a rash at the site of the patch.
- Antidepressants. Tricyclic antidepressant medications, such as amitriptyline and nortriptyline (Aventyl, Pamelor), were originally developed to treat depression. However, they have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain. The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) also has proved effective for peripheral neuropathy caused by diabetes. Side effects may include nausea, drowsiness, dizziness, decreased appetite and constipation.
Therapies
Transcutaneous electrical nerve stimulation (TENS) may help to relieve symptoms. In this therapy, adhesive electrodes are placed on the skin, and a gentle electric current is delivered through the electrodes at varying frequencies. TENS has to be applied regularly.
References
- Peripheral neuropathy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm. Accessed Aug. 22, 2011.
- Peripheral neuropathy. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/sec17/ch234/ch234h.html?qt=peripheral%20neuropathy&alt=sh#v1046209. Accessed Aug. 22, 2011.
- Pai S. Peripheral neuropathy. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/156944782-3/0/1494/62.html#4-u1.0-B978-1-4160-2954-0..50019-3--cesec2_528. Accessed Aug. 25, 2011.
- Dietary supplement fact sheet: Vitamin B12. Office of Dietary Supplements. http://ods.od.nih.gov/factsheets/vitaminb12.asp. Accessed Aug. 25, 2011.
- Bril V, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy. Neurology. 2011;76:1758.
- Ropper AH, et al. Diseases of the peripheral nerves. In: Ropper AH, et al. Adams and Victor's Principles of Neurology. 9th ed. New York, N.Y.: McGraw-Hill Companies; 2009. http://www.accessmedicine.com/content.aspx?aID=3641268. Accessed Aug. 25, 2011.
- Amato AA, et al. Peripheral neuropathy. In: Fauci AS, et al. Harrison's Principals of Internal Medicine. 18th ed. New York, N.Y.: McGraw-Hill Companies; 2010. http://www.accessmedicine.com/content.aspx?aID=9148461. Accessed Aug. 25, 2011.
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