Pain Medication

It is common for people with peripheral neuropathy to experience different degrees of pain. It’s important to identify the type of pain medication that will best manage your symptoms, work with your body chemistry, and complement other treatments.

There are two kinds of pain

Acute pain accompanies illness, inflammation, or injury to tissues. The onset of acute pain is sudden and may occur with emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain will go away over time. Occasionally, acute pain can become chronic.

Chronic pain may be part of the disease itself. Environmental and psychological factors may make it become worse. Chronic pain lasts for longer periods of time than acute pain and is more difficult to treat.

Pain medication options

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.

When over-the-counter pain medications do not relieve the pain associated with peripheral neuropathy, other types of medications and therapies are available, including prescription nonsteroidal anti-inflammatory drugs, narcotics, antidepressants, and topical medications.

COX-2 Inhibitors (includes Celebrex®)
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 (Opioids)
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 (Ultram®)
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).

Anti-depressants as pain relievers
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) 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®)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) 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®)

Norepinephrine reuptake inhibitors (NRIs) 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®)

Serotonin receptor modulators 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®)

 

Mexiletine
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.


Alpha-2 Andrenergic Agonists

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.

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