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You should consult your local pain clinic
for advice specific to your case. The following drugs have
been found to be useful by some people. Some have found greater
relief than others, and some have not found any of them to be particularly
helpful. There is nothing that I have found that has eliminated the
pain, but some have decreased it somewhat.
The literature suggests that current therapies can result
in a 30 to 50% reduction in pain. This is helpful, but not total
elimination of pain that all of us would like to achieve.
I am not a strong advocate of taking
medications, and I like to be drug free. Others do not mind
taking drugs. My advice would
be to follow your physicians advice, but to let him/her know your personal
biases so that the therapy can be appropriate for both your condition and
your preferences.
Currently I know of no guidelines available from
professional organizations for the treatment of painful neuropathy.
I have included a small amount of
information on each drug that has been mentioned to me as possibly
useful. You may find more information on each drug by searching the
internet using the names provided. Again, your particular therapy
should be directed by your physician.
Antidepressant Drugs
Tricyclic Antidepressants
These drugs have been well studied. They
are reported to reduce pain by 50% in about a third of patients. The
side effects can be a problem for some people.
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Amitriptyline (Elavil®) - Member of the
tricyclic antidepressant family |
This is a commonly
used first line drug for chronic pain, including nerve pain. It may
be the best drug available for chronic nerve pain, however it also has
significant side effects. These include drowsiness, constipation
among others. Typically the dose used for nerve pain is less than
that for treatment of depression. I found it made me too tired, even
after being on it for a while. It did dull the pain somewhat, but it
took weeks to work. Many have reported excellent results with this
medication. It may take weeks before the total effect is known.
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Nortryptiline (Pamelor®) - Also
a member of the tricyclic antidepressant family |
Some have found this choice to
have less side effects than taking amitriptyline.
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Desipramine - Also
a member of the tricyclic antidepressant family |
Selective Serotonin-Reuptake Inhibitors
Marginal benefit, usually not as
good as the tricyclics
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Paroxetine
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Citralopram
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Other
Antidepressants
| Venlafaxine (Effexor®) |
Another anti-depressant medication
that has been used for chronic pain, with some success. I have not
tried it, and do not know much else about it.
| Bupropion SR |
This is a non-tricyclic
antidepressant, which has recently been reported to be effective in
treating neuropathic pain. The reference listed found that most
patients reported a decrease in pain when on this medication. The
most common side effects were dry mouth, insomnia and headache. The
long term effectiveness was not studied, as the results were based on a 6
week trial.
REFERENCE
ANTICONVULSANT
DRUGS
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Carbamazepine - Thought to be
effective for trigeminal neuralgia, but limited success for other painful
sensory neuropathies. Oxcarbazipine is an analog that is better
tolerated in some patients.
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Phenytoin - Similar activity to
Carbemazepine. Not used very often as a first line drug for painful
neuropathy.
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Gabapentin (Neurontin®) |
Neurontin is one of
the newer anti-seizure medications that has been used with some success in
treating chronic nerve pain. It is a very popular drug right now,
although it's mechanism of action is unknown, as far as I know. It
does provide some relief, and I have not had too many side effects.
Optimal dosage is still being determined. My personal experience is
that ramping the dosage up slowly was better than trying to ramp it up
quickly. It does have to be taken multiple times a day, because it
does not last long (short half-life).
| Lamotrigine (Lamictal®) |
Another anti-seizure medication
that has been used with some success with chronic neuropathic pain. The
mechanism of action is unknown.
ANTIARRHYTMIC DRUGS
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Mexiletine - oral analogue of
lidocaine (local anesthetic). Data is mixed as to whether it is at
all helpful.
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N-Methyl-D-Aspartate
Glutamate Antagonists
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Dextromethorphan - Beneficial in
some, but causes significant sedation.
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Narcotic and
Nonnarcotic Analgesics
Side effects and concern about
addiction remain problems for the narcotics and treatment of chronic pain.
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Oxycodone - Some data indicates it
is somewhat effective, but with side effects.
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Tramadol - May be as effective with
less side effects.
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LEVODOPA
Single study indicates some
efficacy, not much data at this point.
TOPICAL AGENTS
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Capsaicin - effective for some, see
other page regarding this. Cream
available for treatment of skin, and some candies available for intra-oral
treatment..
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Lidocaine - effective for short
periods of time, skin and oral formulations available. See
Lidocaine page
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OTHERS
| Lioresal (Baclofen®) |
Usually used for muscle
relaxation/spasticity, but has been used by some for chronic nerve
pain. Mechanism of action is unknown as far as I know.
| Tramadol (Ultram®) |
A pain reliever for moderate to
severe pain. The mechanism, as far as I know, is unknown. I
have tried this once, with limited success. It has a significant
list of contraindications, including some of the other medications on this
list.
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Clonazepam (Klonopin®) |
Clonazepam is a benzodiazepine,
and is commonly used for seizures. It is used for chronic pain, but
is generally not considered a first line drug at this point. I have
found it useful at night, so that I can sleep with the pain. I have
not used this drug during the daytime.
References: N Engl J Med 2003;
348:1243-55
Trademarks registered to the
respective pharmaceutical companies.
03/30/03 |
