Treatments and drugs

By Mayo Clinic Staff

One goal of treatment is to manage the condition causing your neuropathy. If the underlying cause is corrected, the neuropathy often improves on its own. Another goal of treatment is to relieve the painful symptoms.

Medications

Many types of medications can be used to relieve the pain of peripheral neuropathy, including:

  • Pain relievers. Mild symptoms may be relieved by over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs. For more-severe symptoms, your doctor may recommend prescription painkillers.

    Medications containing opioids, such as tramadol (Ultram ER) or oxycodone (Roxicodone), can lead to dependence and addiction, so these drugs are generally prescribed only when other treatments fail.

  • Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Carbatrol, Tegretol) and phenytoin (Dilantin, Phenytek) were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects may include drowsiness and dizziness.
  • Immunosuppressive medications. Medications to reduce your immune system's reaction, such as prednisone, cyclosporine (Sandimmune) and azathioprine (Imuran, Azasan), may help people with autoimmune conditions.
  • Capsaicin. A cream containing this naturally occurring substance found in hot peppers can cause modest improvements in peripheral neuropathy symptoms.

    As with spicy foods, it may take some time and gradual exposure to get used to the hot sensation this cream creates. Generally, you have to get used to the heat before you can experience pain relief. Doctors may suggest you use this cream with other treatments.

  • Lidocaine patch. This patch contains the topical anesthetic lidocaine (Xylocaine). You apply it to the area where your pain is most severe, and you can use up to four patches a day to relieve pain. Lidocaine may help reduce pain from peripheral neuropathy.
  • Antidepressants. Certain tricyclic antidepressant medications, such as amitriptyline, doxepin and nortriptyline (Aventyl, Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.

    The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also may effectively treat the pain of peripheral neuropathy caused by diabetes.

    Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite and constipation.

Therapies

Transcutaneous electrical nerve stimulation (TENS) may help to relieve symptoms. In this therapy, adhesive electrodes are placed on the skin and a gentle electric current is delivered through the electrodes at varying frequencies. TENS should be applied for 30 minutes daily for about a month.

People with certain inflammatory conditions may benefit from procedures such as plasma exchange and intravenous immune globulin, which help suppress immune system activity.

In plasma exchange, your blood is removed, a machine removes immune cells from your blood, and your blood is returned to your body. In immune globulin therapy, you're given high levels of proteins that work as antibodies (immunoglobulins), which can help reduce your immune system's activity.

Try using hand or foot braces to help support your movement if you have muscle weakness. You may also need physical therapy to improve your movements.

If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you may need surgery to reduce pressure on your nerves.

A procedure using infrared therapy may help improve sensation in the feet of people with diabetes. Researchers are studying the effects of infrared therapy and a therapy that uses magnetic foot soles to improve neuropathy in people with diabetes.

Aug. 13, 2013

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