Peripheral Neuropathy Treatments

Plasmapheresis, a procedure that removes excess antibodies from the bloodstream, is used in the treatment of lupus and multiple myeloma. During this procedure, whole blood is removed from the body and the blood plasma and blood cells are separated. Antibodies are found in plasma, so the plasma is discarded. The blood cells are recombined with a plasma substitute, or donor plasma, and may be returned to the body.

Anesthetic nerve blocks are a method used to treat and understand the source of nerve pain. A patient receives an injection of an anesthetic directly into a bundle of nerves. The injection prevents the nerves from sending pain signals to the brain, thus providing temporary pain relief. If the nerve block works, it may help identify affected nerves and lead to better pain treatment.

Two kinds of drugs used as nerve blocks are:

• Lidocaine
• Bupivacaine

Transcutaneous electronic nerve stimulation (TENS) is a method of therapy that may be used to treat nerve pain. It works by inhibiting pain signals from reaching the brain. It is a drug-free therapy that works by placing very small electrical impulses on specific nerve paths. The electrical impulses are delivered to the nerves through electrodes that are placed on the skin. Although it doesn’t work for everyone or all types of pain, TENS may be prescribed in combination with other treatments, primarily to provide relief from acute forms of nerve pain.

Over-the-counter pain relievers are the most frequently purchased medicines. They can help treat mild-to-moderate pain associated with peripheral neuropathy. There are two main types of over-the-counter pain relievers.

Acetaminophen

Acetaminophen is used to treat mild-to-moderate pain and reduce fever, but it is not very effective at reducing inflammation. Acetaminophen provides relief from pain by elevating the amount of pain you can tolerate before you experience the feeling of pain. The best-known brand of acetaminophen is Tylenol®, but there are also many generic versions available.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain, swelling, stiffness and inflammation. Two drugs in this category, ibuprofen and naproxen, also reduce fever. NSAIDs work by reducing the body’s production of prostaglandin, an enzyme that sends pain messages to the brain. When these drugs are taken regularly, they build up in the blood to levels that fight pain caused by inflammation and swelling, and also provide general pain relief.

There are several different types of NSAIDs.

These include:

• Aspirin (Bayer® Aspirin, Ecotrin®, Excedrin®, St. Joseph’s®, and many others)
• Ibuprofen (Advil®, Motrin®, and others)
• Ketoprofen (Orudis®)
• Naproxen (Aleve®)

Many over-the-counter pain medications are also available in generic formulas.

COX-2 inhibitors are a relatively new type of

nonsteroidal anti-inflammatory drug (NSAID)

that reduces pain and inflammation by blocking a specific enzyme (COX-2) in the body. COX-2 inhibitors are less likely to cause gastrointestinal problems or bleeding than traditional NSAIDs (e.g., aspirin or ibuprofen) and may be a safer alternative for certain patients. However, because COX-2 inhibitors do not inhibit blood clotting (thin the blood), as do other NSAIDs — especially aspirin — they should not replace aspirin as a heart treatment.

COX-2 inhibitors include:

• Celecoxib (Celebrex®)
• Rofecoxib
• Valdecoxib (Bextra®)

Narcotics, also known as opioids, are used to relieve severe and chronic pain. They are prescribed when other pain medications and therapies do not seem to work. These drugs are often used in combination with other medications such as antidepressants, anticonvulsants, and non-narcotic pain relievers. Opioids are the strongest pain medicines available and may become addictive if used on a long-term basis.

There are different types of opioids, which include:

• Codeine
• Hydrocodone
• Hydromorphone (Dilaudid®)
• Meperidine (Demerol®)
• Methadone (Dolophine®)
• Morphine (MS Contin® and others)
• Oxycodone (OxyContin®)

Tramadol is a pain medication prescribed to treat moderate-to-severe acute pain. Its effectiveness in treating chronic pain is still being studied. It has properties similar to both opioids (narcotics) and antidepressants. Tramadol reduces pain by interfering with pain signals to the brain (like an opioid) and by affecting neurotransmitters (like an antidepressant).

Sometimes, drugs developed and used to control other conditions are effective pain relievers. In addition to relieving depression, many antidepressant drugs can relieve chronic pain. These drugs also may improve sleep quality, which may in turn help reduce pain. In some cases, antidepressants work by treating accompanying depression that makes chronic pain more difficult to handle.

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) (e.g.,Cymbalta®)
• Norepinephrine Reuptake Inhibitors (e.g., Wellbutrin®)
• Serotonin Receptor Modulators (SRM)

Are a new type of antidepressant drug that is used to treat pain caused by neuropathy. SSRIs restore the chemical balance in the brain’s nerve cells. Common SSRIs used to treat neuropathy pain include:

• Paroxetine hydrochloride (Paxil®)
• Fluoxetine (Prozac®)
• Sertraline (Zoloft®)
• Citaprolam (Celexa®)
• Fluvoxamine (Luvox®)

Are a new type of antidepressant medication that may alleviate pain caused by neuropathy. These drugs affect the nerve cells in the brain and inhibit the production and release of specific neurotransmitters (serotonin and norepinephrine).

Examples of serotonin and norepinephrine reuptake inhibitors include:

• Duloxetine (Cymbalta®)
• Venlafaxine (Effexor®, Effexor XR®

Are a type of antidepressant medication that may reduce neuropathic pain. These drugs affect the nerve cells in the brain and inhibit the reuse of specific neurotransmitters (dopamine, serotonin, and norepinephrine), which may alleviate depression by achieving a chemical balance in the brain.

Examples of norepinephrine reuptake inhibitors are:

• Bubropion (Wellbutrin®, Wellbutrin SR®)
• Ludiomil (Maprotiline®)

Are antidepressant medications that may relieve neuropathic pain. These drugs work to achieve chemical balance within the brain by increasing the levels of serotonin and norepinephrine available to transmit messages to other nerves.

Serotonin receptor modulators include:

• Nefazodone (Dutonin®)
• Trazodone (Desyrel®)

Topical medications are creams, ointments, gels, lotions or patches that you apply directly on your skin to provide relief from nerve pain and inflammation. The active drugs in these medications are absorbed through the skin and provide localized pain relief.

Two types of topical medications used to treat neuropathy pain are:

• Local anesthetics
• Analgesics

LOCAL ANESTHETICS
Local anesthetics are used to treat localized pain. They work by numbing the area and blocking the pain where they are applied. Some local anesthetics are:

EMLA – A prescription cream that numbs the skin within an hour of application and lasts for a few hours.
Lidocaine patch (Lidoderm®) – A prescription patch that is applied directly to the skin to relieve nerve pain.
Over-the-counter products – Many ointments, creams and lotions are available to provide relief from mild pain symptoms.

Nonprescription topical pain relievers (analgesics) — which are rubbed on the skin — are available to treat pain from neuropathy. These medications contain capsaicin (Capzasin-P®, Dolorac®, Zostrix® are brand names). A substance made from the seeds of hot chili peppers, capsaicin may reduce the ability of nerve cells to transmit pain messages to the brain. Capsaicin and other topical pain relievers provide temporary relief from minor pain located close to the skin’s surface.

Mexiletine (Mexitil®), an orally taken form of lidocaine, was originally approved to treat irregular heartbeats, but sometimes is effective in the relief of chronic nerve pain. Mexiletine reduces pain by adhering to peripheral nerves and reducing pain signals carried from the peripheral nerves to the central nervous system and brain. Over time, as mexiletine bonds to the peripheral nerves, the feeling of pain is diminished. Mexiletine is being used experimentally to treat pain associated with different kinds of peripheral neuropathy.

There are two alpha-2-adrenergic agonists that have some evidence as pain relievers: tizanidine (Zanaflex®) and clonidine (Catapres®). There are some studies showing that tizanidine can be effective for tension-type headache, back pain, neuropathic pain and myofascial pains. Clonidine has been used to treat neuropathic pain that is not responding to other treatment or therapy.

Biofeedback is a therapy that uses an electrical machine to help you identify, monitor and learn to consciously manage your body’s physiological responses. Biofeedback helps people learn to alter activities usually controlled by the autonomic nervous system such as heart rate, blood pressure, and muscle activity. It also can be used to learn relaxation techniques that can reduce stress, headaches and chronic pain. Biofeedback therapy enables people to learn how to consciously manipulate a body function by using feedback gathered by electronic sensors that measure various body functions such as brain waves, temperature, heart rate and muscle tension. The information provided by the electronic instruments enables a person to learn ways to control, reduce or avert certain physical reactions such as those that increase feelings of stress and pain. Certified biofeedback therapists monitor the electronic equipment and train patients in the most effective techniques to control their specific symptoms.

Acupuncture is an ancient Chinese treatment that is performed today throughout the United States and Europe. Acupuncture involves inserting very thin needles into the body at specific points. Many people believe that acupuncture is an effective therapy to reduce pain. For some people with peripheral neuropathy, acupuncture acts as a complementary therapy because it may reduce the need to take pain-relieving drugs. Presently, research results are mixed as to whether or not acupuncture reduces chronic pain. A list of doctors that practice acupuncture is available from The American Academy of Medical Acupuncture.

Relaxation techniques are designed to release tension that could make pain worse. A number of techniques exist including breathing exercises, visualization, meditation, massage and yoga.

Splints can be helpful for people suffering from muscle weakness as the result of peripheral neuropathy. Also, making ergonomic changes to one’s workplace may reduce the symptoms of carpal tunnel, and help alleviate the pain from peripheral neuropathy.