Neuropathy Treatments and Medications

If you’re experiencing constant pain or numbness in your hands or feet, you could be experiencing neuropathy, a health condition that affects the normal activity of nerves in the peripheral nervous system. Understanding what neuropathy is and how to treat it both at home and with medications are great first steps in managing your pain. Keep reading to learn what the condition is, the causes of neuropathy, and how this condition can be treated.

What is neuropathy?

Neuropathy, also known as peripheral neuropathy, is any condition that affects the peripheral nerves of the central nervous system and how they function. Not to be confused with carpal tunnel syndrome, neuropathy usually manifests in the form of muscle weakness or pain in the hands and feet. Diabetic neuropathy is just one form of neuropathy that can occur if you have diabetes.

Some of the most common symptoms of neuropathy include pain, numbness, weakness, or the sensation of walking on pins and needles. Though symptoms can range from mild to moderate, they’re rarely life-threatening. There are a variety of treatment options available to help ease the pain, but the most common treatment is nerve pain medications which include antidepressants, pain medications, or topical creams.

More than 20 million people in the United States have some form of peripheral neuropathy, but this figure may be significantly higher because not all people with neuropathic symptoms are tested for the disease, and some tests don’t look for all forms of neuropathy. Although the condition may last for years, neuropathic pain can often be reduced with a combination of treatments, including medications, injections, and nerve stimulation.

According to the U.S. Department of Health & Human Services (DHHS), one agent that has been FDA-approved for neuropathy treatment is a high-dose capsaicin patch. Other agents recently evaluated in trials include topical ketamine, clonidine, cannabinoids, and dextromethorphan.

How is neuropathy diagnosed?

One of the most common causes of neuropathy is diabetes, but the condition can also be caused by infection, a spinal cord injury, or exposure to toxins. Other health conditions that may cause neuropathy include autoimmune diseases like rheumatoid arthritis or lupus, chronic kidney disease, HIV/AIDS, or shingles. Older adults and those with type 2 diabetes are more at risk to experience neuropathy, which is a common complication of uncontrolled diabetes.

If you’re not sure whether you have neuropathy, schedule an appointment with your primary healthcare provider right away, as he or she can help diagnose the issue and provide further medical advice.

Here’s what you can expect at your appointment:

• Blood test: Done in conjunction with a physical exam, this type of test can detect vitamin deficiencies, diabetes, abnormal immune system conditions, and other health issues that could be causing neuropathy.

• Nerve function tests: These tests can help detect nerve damage in your body. Your doctor will likely perform electromyography (EMG) that records activity in your muscles to detect any nerve damage. While the EMG is happening, your doctor may also perform a nerve conduction velocity (NCV) study and record your nerves’ responses to electrical currents.

• Neurological exam: Your doctor may perform this exam and check for tendon reflexes, muscle strength, balance, posture, and your ability to feel different sensations. Monofilament test is a yearly foot examination performed on diabetic patients to screen for neuropathy.

• Imaging test: Your doctor may order an MRI or a CT scan to look for tumors or other abnormalities that are causing pain throughout your body.

• Nerve biopsy: If other tests come back normal, your doctor may seldom perform a nerve biopsy. This involves removing a portion of a sensory nerve to look for abnormalities.

• Skin biopsy: Your doctor could also rarely perform a skin biopsy to examine your skin and look for a decrease in nerve endings.

• Spinal tap: A spinal tap or lumbar puncture is sometimes recommended to help identify an infection or inflammation associated with neuropathy.

Though primary care physicians can diagnose neuropathy, they may refer you to a podiatrist, physical therapist, neurologist, or physical rehabilitation center for more directed treatment.

Questions your doctor may ask you

During your appointment, your doctor may ask the following questions to better inform the diagnosis of neuropathy:

• When did you start experiencing pain?

• How severe is your pain?

• Where do you feel pain?

• Do you have any underlying medical conditions, such as diabetes or alcoholism?

• Have you recently undergone any chemotherapy treatments?

• Have you been exposed to any toxins recently?

Questions you should ask your doctor

If you have neuropathy, it’s important to understand its causes and course of action over the short and long-term. Here are some of the more important questions to ask your doctor during your appointment:

• What causes neuropathy?

• Is the condition temporary or permanent?

• What treatments are available to me?

• What medicine can I take for the pain?

• Are there common side effects from the medicine that I should be aware of?

• What alternative treatments or therapies exist for the pain?

• Should I make any lifestyle changes to help ease the pain?

• Are there local support groups for those with neuropathy?

Neuropathy treatment options

After you receive your diagnosis, your doctor should provide you with a variety of options to help relieve the pain associated with your neuropathy. Treatment for peripheral neuropathy will depend on the underlying cause, but in most cases, treatment will consist of antidepressants like amitriptyline, anticonvulsants, pain medications like oxycodone, anti-seizure medications, pain-relieving creams, physical therapy, surgery, or corticosteroid injections for increased nerve pressure.

According to Dr. Heather Finlay-Morreale, doctor and assistant professor of pediatrics at the University of Massachusetts Medical School, “Medications such as gabapentin, pregabalin, tricyclic antidepressants, or duloxetine are helpful for neuropathy. Topicals such as lidocaine, menthol, methyl salicylate, and capsaicin are also helpful.”

Anis Rehman, MD, a board-certified endocrinologist at District Endocrine, recommends excluding any non-diabetic etiologies, then stabilizing glycemic control and adding medications to treat neuropathy symptomatically.

Though there is a treatment to help ease symptoms, there is no cure for neuropathy. The goal of neuropathy treatment is to restore bodily function, relieve pain, and reduce discomfort.

How to prevent neuropathy

According to the National Institute of Neurological Disorders and Stroke, a new adjuvanted vaccine against shingles prevents more than 95% of neuropathy cases and is widely recommended for people over 50, including those who have had previous shingles or been vaccinated with the older, less effective vaccine.

In addition to this new vaccine, there are some lifestyle changes that can ease symptoms of peripheral neuropathy and prevent it from recurring. These include exercising, eating a balanced diet, and maintaining healthy body weight.

Some other ways to prevent neuropathy include:

• Receiving treatment for diabetes and other medical conditions that cause neuropathy

• Regulating blood glucose levels

• Avoiding excessive alcohol intake and eating healthy

• Stopping smoking

Neuropathy medications

Your doctor may prescribe one or more medications in the following drug classes to help ease neuropathy symptoms. Talk to your doctor about which medications are safe for you, and remember to always use over-the-counter medicine as directed.

Anticonvulsants

Also known as anti-seizure or anti-epileptic drugs, anticonvulsants are typically used to treat seizure disorders. They can also be used to treat bipolar disorder, borderline personality disorder, and neuropathic pain. The exact way these drugs work is unclear, but they’re thought to minimize the effects of the nerves that cause pain. Some popular anticonvulsants are Gralise, Neuraptine, and Lyrica. Side effects include dizziness, fatigue, nausea, drowsiness, and weight gain.

Anesthetics

In general, anesthetics work by interrupting nerve signals in your brain and body and preventing your brain from processing pain. Lidocaine is an anesthetic drug that is sometimes used to treat neuropathy.

Antidepressants

Antidepressants are medications used to treat depression, anxiety disorders, chronic pain, and some addictions. They work by balancing the chemicals in your brain, called neurotransmitters, which affect mood and emotions.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed by a healthcare professional followed by serotonin and norepinephrine reuptake inhibitors (SNRIs), like duloxetine, and monoamine oxidase inhibitors (MAOIs). Some of the more common brands are Cymbalta, Prozac, Zoloft, Celexa, and Nardil. Common side effects include dry mouth, headaches, and sexual dysfunction.

Opioids

Narcotic drugs work by binding to special receptors in the brain and in the peripheral nervous system and reducing nerve excitability that leads to pain. These types of opioid pain relievers can be short or long-acting. Examples of opioids are codeine, fentanyl, hydrocodone, morphine, Nucynta, and oxycodone. Common side effects include nausea, vomiting, and constipation.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs are some of the most common forms of pain relievers. They work by reducing the production of prostaglandins that promote inflammation and pain. In addition to relieving pain, they decrease fever, prevent blood clots, and reduce inflammation. Selective COX-2 inhibitors are a type of NSAID that directly targets cyclooxygenase-2, COX-2, an enzyme responsible for inflammation and pain.

The most common types of NSAIDs include Advil, Motrin, Bayer, Ultram, and Aleve. Side effects may include headaches, stomach pain, stomach ulcers, dizziness, and high blood pressure.

What is the best medication for neuropathy?

The best medication for neuropathy depends on the patient’s medical condition, medical history, and medications they may already be taking that could interact with neuropathy medication as well as the patient’s response to treatment.

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Best medications for neuropathy