Treatment Options for Neuropathic Pain
Currently there is no proven treatment to prevent or cure neuropathic pain (neuropathy or nerve pain). Instead, the primary goals of treatment are to reduce the pain as much as possible, balance the negative side effects of the treatment, and help patients manage any unresolved pain.
It is thought that early identification and treatment of intractable, chronic pain can help in effectively treating the pain. Once neuropathic pain is well established, however, it tends to become more difficult to successfully manage and more aggressive treatments may be required.
Back Pain and Neuropathy
Treatment of nerve pain related to the back or spine has traditionally been through a combination of medications and nerve blocks, and may include implantable systems. In addition, physical therapy, transcutaneous electrical nerve stimulation (TENS) and/or psychological therapy and occupational therapy for coping with the pain may be effective.
Because of the complex nature of neuropathic pain, a multi-disciplinary, integrated approach to managing the pain is often useful. For example, a comprehensive pain management and rehabilitation program back pain patients with chronic, neuropathic pain might include working with:
- A spine specialist or pain management specialist, such as a spine surgeon, anesthesiologist, physiatrist, or neurologist, for medical management of the pain
- A physical therapist or occupational therapist to assist with physical rehabilitation, exercise and overall conditioning
- A psychologist who specializes in pain management to develop techniques for managing the pain and alleviate associated symptoms of depression, sleeplessness, etc.
Types of Medications for Neuropathic Pain
The three types of medications most commonly prescribed for nerve pain include:
- Antidepressants or tricyclic antidepressants (TCA’s), such as Amitriptyline and Nortriptiline. The newer selective serotonin reuptake inhibitors (SSRI) antidepressant medications (such as Prozac) are not considered as effective for this condition as tricyclic antidepressants.
- Anticonvulsants (also called neuroleptic medications) such as carbamazepine, felbamate, valproic acid, clonazepam, and phenytoin. A newer drug, gabapentin (Neurontin), is also considered effective and is generally well tolerated by most patients
- Local anesthetics, such as intravenous application of lidocaine, tocainide or mexiletine can often provide relief
In This Article:
- Treatment Options for Neuropathic Pain
- Neuropathic Pain Management and Medications
- Therapeutic Nerve Blocks for Neuropathy
- Spinal Cord Stimulators and Pain Pumps – Implantable Systems for Neuropathy
- Additional Treatments for Nerve Pain
- Treatment for Neuropathic Pain Video
Antidepressants (TCA’s) and anticonvulsants are typically the first line of treatment, and the combination of the two medications is thought to be particularly effective. Frequently, a combination of antidepressants, anticonvulsants and local anesthetics may be prescribed.
Additionally, topical capsaicin (pepper creams) can be applied to the skin for pain relief, although it may take multiple daily applications for several weeks before it is effective.
Generally, most studies have shown that opioid analgesics (such as morphine) and NSAIDs (such as ibuprofen, Cox-2 inhibitors) are not effective in alleviating most types of neuropathic pain. However, for different patients and different forms of neuropathic pain, these medications may be of value. Relatively high doses of opioids may be required to be effective.