If you’re living with nerve pain — also known as neuropathic pain or neuralgia — you’re likely wondering what your treatment options are. They’ll typically depend on the underlying cause of your nerve pain. Nerve pain treatment options include oral medications, topicals, and nerve stimulation.1,2 Together, you and your doctor can work together to better manage your pain and help you lead a more comfortable life.
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Oral Medications for Nerve Pain
Currently, there are only a handful of medications approved by the U.S. Food and Drug Administration (FDA) for treating nerve pain — instead, your doctor may prescribe medications “off-label.” Anti-seizure medications and antidepressants help treat nerve pain by interfering with pain signals sent by damaged or irritated nerve cells (neurons).
Anti-Seizure Medications for Nerve Pain
Gabapentin (Neurontin®) is a seizure medication that’s also approved for treating postherpetic neuralgia, a type of burning nerve pain that develops after a shingles infection.3 Pregabalin (Lyrica®) is an FDA-approved treatment for nerve pain caused by diabetic peripheral neuropathy (nerve pain in the feet and legs caused by uncontrolled blood sugar levels), spinal cord injuries, and postherpetic neuralgia.4
Other medications prescribed off-label for treating nerve pain include topiramate (Topomax®), lamotrigine (Lamictal®), and carbamazepine (Tegretol®). Your doctor may prescribe you one of these medications if you have trigeminal neuralgia (TN), a condition that causes sharp, searing pain along one side of your face.5
It’s important to note that just because your doctor has prescribed you an anti-seizure medication, it doesn’t mean that seizures are causing your nerve pain. Researchers believe these medications help calm the overactive electrical signaling in your nerves that’s responsible for causing pain.
Common side effects of anti-seizure medications include:5
- Nausea or vomiting
- Dizziness or loss of coordination
- Swelling in your legs and feet
- Changes in your vision
Antidepressants for Nerve Pain
You might not think that some antidepressants can help treat nerve pain, but studies show they’re effective for treating several types — including diabetic neuropathy, nerve pain from multiple sclerosis (MS), postherpetic neuralgia, and TN. Doctors and researchers aren’t quite sure how antidepressants work to treat nerve pain, but they believe it may be due to their effects on neurotransmitters in the spinal cord. These chemical messengers likely play a role in sending pain signals.6
Your doctor may prescribe an antidepressant along with an anti-seizure medication to help you better manage your nerve pain. There are two main classes of antidepressants used to treat nerve pain: tricyclic and selective serotonin and norepinephrine reuptake inhibitors (SNRIs).6
Examples of tricyclic antidepressants include:
- Protriptyline (Vivactil®)
- Nortriptyline (Pamelor®)
- Doxepin (Silenor®)
Antidepressants take several days to weeks to begin working, so it may take some time for your symptoms to improve. Tricyclic antidepressants are also associated with some unwanted side effects — your doctor will likely start you out on a low dose and increase it as needed. Examples of side effects you may experience include:
- Blurry vision
- Lightheadedness or fainting due to a drop in blood pressure after standing up (known as orthostatic hypertension)
- Dry mouth
- Trouble concentrating or thinking clearly
- Difficulty urinating (peeing)
- Difficulties with sexual arousal and intercourse
- Abnormal heart rhythm (arrhythmias)
Examples of SNRIs include:
- Duloxetine (Cymbalta®)
- Venlafaxine (Effexor XR®)
- Desvenlafaxine (Pristiq®)
SNRIs are typically associated with fewer side effects compared to tricyclic antidepressants. You may experience:
- Trouble sleeping (insomnia)
- An increase in blood pressure
- Dry mouth
- Excessive sweating
Topical Treatments for Nerve Pain
Over-the-counter topical creams, ointments, or patches can provide temporary relief from nerve pain. You can find several options in your local grocery store or pharmacy, depending on the ingredients and strength you’re looking for. Topical creams and patches with prescription-strength capsaicin are also used to treat severe diabetic neuropathy.
Your doctor may recommend trying a topical formulated with:7-9
- Capsaicin: Capsaicin is the chemical responsible for giving chili peppers their spicy flavor. It works by blocking your nerves from sending pain signals. Examples include Icy Hot®, Capzasin-HP®, and Zostrix®.
- Menthol: Menthol is a compound that gives mint products their cool, refreshing flavor. It also creates a cool, tingling sensation on the skin to ease nerve pain. Examples include Bengay®, Icy Hot®, and Absorbine Plus®.
- Lidocaine: Lidocaine is a local anesthetic that helps numb an area of skin to relieve nerve pain. Examples include Aspercreme®, Icy Hot Max®, and Salonpas®.
Peripheral Nerve Stimulation
If your nerve pain hasn’t improved with anti-seizure medications, anti-depressants, or topicals, your doctor may recommend a technique known as peripheral nerve stimulation. This treatment uses an extremely thin electrode that’s placed under the skin near the affected nerve. Your doctor or neurologist will use ultrasound to guide the electrode into place.10,11
They’ll secure the other end of the electrode (known as the lead) outside of your skin. The lead connects to a transmitter with a battery so the device can be turned on. The transmitter sends weak electrical signals into the electrode to stimulate the nerve, tricking it into reducing or turning off the pain signals it normally sends.
You can adjust the settings on your transmitter to offer more or less pain relief as needed. You’ll notice a gentle, tingling sensation as the electrical signals are sent to your nerves. Peripheral nerve stimulation is used to treat nearly 20 different types of nerve pain, including the most common ones we’ve discussed so far.
Because the electrode is inserted underneath your skin, there’s a risk of pain, infection, bleeding, or damage to nearby nerves after the procedure. Some people also report experiencing nausea, headaches, or dizziness when using peripheral nerve stimulation. There’s also a chance that the procedure or technique won’t work — your doctor can discuss your individual risks with you, as well as other options, such as a spinal cord stimulator.12
The Future of Nerve Pain Treatments
The nervous system is extremely complex, and doctors and researchers continue to learn more about it as time goes on. Nerve pain can be difficult to diagnose and treat — the development of new therapies can help people live healthier, more comfortable lives with chronic nerve pain. Any new nerve pain medications or therapies must go through clinical trials for them to be approved by the FDA.