Neuropathic Pain

When nerves are hurt or do not work the way they should, they can cause “neuropathic” pain.  Neuropathic pain is often described as intense, burning, tingling, shooting, or feeling like electric shocks.  The pain can be constant or it can come and go.  Some people may have numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness.  Sometimes, something as simple as a light touch, cold, or even taking a shower can result in severe pain. 

 

This handout explains some of the treatments for this type of pain.  If you have questions or concerns about your pain and its treatment or want more information, check with your doctor, nurse, or pharmacist.

 

Treatment

 

Doctors do not yet know how to heal damaged nerves, so neuropathic pain is hard to treat.  Treatment is centered on pain reduction and improvement in function (how one can live with a good quality of life).  As with any pain condition caused by injured nerves (neuropathic pain), often more than one treatment option is required.  Effective treatment most often requires a blend of medicines, exercise, and other therapies.  It can take some time to find the combination that is right for you. 

 

Medicines

 

Your doctor may prescribe one or more medicines for you.  Commonly used medicines may include opioids, anticonvulsants, antidepressants or anesthetics.  Examples are listed below. Most medicines used for neuropathic pain work by helping to “calm down” the nervous system and reduce the pain.

 

Anticonvulsants: Anticonvulsant medicines are mainly used to treat seizures.  Certain of these have been reported to reduce pain.  These include:

 

• gabapentin (Neurontin®)
• pregabalin (Lyrica®)
• carbamazepine (Tegretol®)
• topiramate (Topamax®)
• lamotrigine (Lamictal®)
• tiagabine (Gabitril®)
• zonisamide (Zonegran®)
• others

 

Antidepressants:  Some drugs used to treat depression may also reduce pain and help you sleep even if you do not have depression.  These include:

 

• amitriptyline (Elavil®)
• desipramine (Norpramin®)
• doxepin (Adapin®, Sinequan®)
• duloxetine HCI (Cymbalta®)
• imipramine (Tofranil®)
• nortriptyline (Pamelor®)
• mirtazapine (Remeron®)
• trazodone (Desyrel®)
• others

 

Opioids (narcotics):  Opioids are medicines that act directly to reduce pain.  For more information about opioids, ask your doctor or nurse or request a copy of Health Facts for You #4659 (Opioid Analgesics).

 

Local Anesthetics:  These medicines reduce pain by blocking electrical signals in nerves.  Different anesthetics can be given by mouth, intravenously, under the skin, or by placing a patch on the skin.  These include:

 

• lidocaine (Xylocaine® or Lidoderm® patch)
• mexiletine (Mexitil®)

 

Steroids:   Steroids may be used short-term to help reduce inflammation, swelling, and pain.  They may be injected or taken by mouth.  Because of side effects (ask your doctor or nurse) they must be used cautiously. 

 

Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs reduce inflammation and relieve certain types of pain but are generally not helpful for neuropathic pain.

 

Advice on Taking Medicines for Neuropathic Pain

 

If your doctor starts you on a medicine for neuropathic pain, you most often will start with a low dose of the medicine.  Slowly, you will increase the dose until you either have pain relief or decide that the drug does not work for you.  Many of these drugs may not have much effect in a single dose.  You must take them regularly over many weeks before you know if they will work for you.  Be sure to take them exactly as prescribed.  Ask your doctor or nurse if you have any questions about using them. 

 

Side effects vary from drug to drug.  Most of them can cause drowsiness, lightheadedness, or dizziness.  These effects usually fade as you become used to the drug.  For information on other side effects, talk to your doctor, nurse or pharmacist. 

 

 

Some drugs require blood tests every so often to check the level of the drug in your blood.  Your doctor or nurse will give you instructions if you need to have your levels checked.

 

If one drug does not work, don’t panic!  There are others that may work for you.  If you need to stop a medicine, don’t just stop taking it suddenly.  Ask your doctor or nurse for instructions on how to safely taper off the medicine. 

 

Other Treatments

 

Your regular doctor may treat your pain or you may be referred to a pain specialist or pain center.  Pain centers focus on pain treatment with a staff of doctors, nurses, therapists, and medical professionals who are experts in pain management.  These centers most often offer a variety of treatments and they treat all types of pain, including neuropathic pain.

 

Pain centers work with your to improve your ability to function physically and emotionally as well as reduce your pain.  

 

Treatments at pain centers may include:

 

Exercise                              

Some exercises can help improve lost motion, increase strength, and reduce pain.  Physical therapists (PTs) and occupational therapists (OTs) will prescribe specific exercises for your problem.  Strengthening, weight bearing, and range-of-motion exercises can help.  “Desensitization” exercises use skin stimulation to help your skin get used to contact.  You will begin with soft, light textures and move to coarser materials.  Desensitization can help you more easily deal with the touch of clothing, bed sheets, or other objects.

 

Modalities                           

Therapists may also use treatments like heat or cold, massage, or electrical stimulation.  TENS is a type of electrical therapy designed to reduce pain by applying a mild electrical stimulus to your skin. 

 

Psychological Treatment       

The stress of dealing with neuropathic pain can be very high.  It is helpful to learn how to cope with and adapt to your pain.  The therapist may suggest treatments including counseling, biofeedback, relaxation training, and other stress-reducing therapies.  Psychological evaluation and therapy are included in most major pain treatment programs.

 

Injections.                           

When your doctors know the specific nerve or nerves causing the pain, injections of local anesthetics, steroids, and/or other agents can sometimes give you relief.  Not everyone with neuropathic pain will benefit from injection therapy.  Ask your doctor or nurse for more information.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 05/03/2007

Copyright © 03/01/2007 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #5878

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