What is a good painkiller for nerve pain

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Understanding nerve pain medication

Nerve pain is also called neuropathic pain. It can be caused by a number of conditions. Sometimes the cause is not known.

There are many treatments for nerve pain. Medication alone is not usually the answer. It can usually only partially relieve the pain. You also need to develop pain management strategies to help you cope. These may include exercise, cognitive behavioural therapy and meditation.

Sometimes the pain can be treated directly if the cause is known. Managing the cause, if it is known, may reduce the pain. Acupuncture and relaxation techniques can help.

Types of nerve pain medicines

Pain relief medications like paracetamol, non-steroidal anti-inflammatory drugs and opioid medications don’t usually work for nerve pain. The best medications for nerve pain are prescribed by a doctor. They are medicines that are also used in other conditions:

• The antidepressant medicines amitriptyline and duloxetine.
• Medicines used for seizures (epilepsy), gabapentin and pregabalin.

Other medications that may work are tramadol, lignocaine, capsaicin and botulinum toxin A.

Important information about nerve pain medication

All medicines can have side effects. Nerve pain medications may not ease the pain immediately. It’s important to build up the dose slowly so the side effects don’t outweigh the benefits.

You can ask your doctor or pharmacist about:

• the side effects of your nerve pain medicines
• the benefits
• what to do if you miss a dose
• what to do if you experience side effects

Talk to your doctor if you feel unwell when taking your medicines.

Do not stop or change your medicines without talking to your doctor.

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Last reviewed: March 2020

When chronic pain comes from the nerves, these nerve pain medications  can help when added to other pain relievers.

For chronic muscle and joint pain, effective therapies include rest, ice and heat, anti-inflammatory medications, and time. Usually, the pain calms down and you feel better.

However, muscle and joints may be only part of the picture. For instance, pain can be coming  primarily from irritated nerves, along with the injured and inflamed muscle or joint.

Often the discomfort is only arising from nerve pain. Typical signs of this "neuropathic" pain include sharp, stinging pain or pain that radiates from one part of the body to adjacent areas. One of the most common causes is diabetes, although it can also be brought on by injury, infection, and some medications.

"People say things like, 'My knee hurts and I feel like it's coming up to the middle of my thigh and down to my shin," says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. "In those cases, the nerve may be involved."

In neuropathic pain, the nerve that was the mere messenger of pain now becomes the actual source. Narcotic pain relievers don't often help and even when they do, they should not be used as a long term solution. Fortunately there are other options. Certain drugs that were originally developed to treat depression and seizure disorders also damp down inappropriate or excessive pain signaling in the nerves.

Nerve pain medications

A variety of drugs can be added to conventional pain relievers to reduce nerve pain. Adding one of these nerve pain medications  won't completely take the pain away, but it may help.

Anticonvulsants: These medications were developed to control seizures, but they also help to blunt pain signals in the nerves. Several are in wide use for chronic pain (see "Medications for nerve pain").

It takes about three to four weeks for the full effect to kick in. Your doctor will usually start you on a low dose and gradually increase it. That reduces side effects.

Antidepressants: Certain types of antidepressants also help to control nerve pain. They may have a synergistic effect in people who experience depression along with chronic pain. Chronic pain often causes depression, and depression can intensify a person's sensitivity to pain; some antidepressants address both. There are three options:

• Tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor). These drugs are prescribed for pain at doses lower than are effective for depression.
• Serotonin–norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor). SNRIs have fewer side effects than tricyclics, although some research suggests they may be less effective.
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), are the most commonly prescribed medications for depression. Some doctors may try these for treating nerve pain, too, but the evidence for effective pain relief is mixed.

Types of pain: Nociceptive vs. neuropathic

• Nociceptive (body) pain comes from damaged tissues outside the nervous system, such as muscles and joints. People say the pain feels aching and throbbing.
• Neuropathic (nerve) pain comes from the nerves that transmit pain signals from the body to the brain. People describe the pain as burning, stinging, or shooting. It may radiate from one area of the body to another. It may be accompanied by numbness and tingling.

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Doctors usually try one type or the other (antidepressants or anticonvulsants), although they can be combined. They are taken daily in addition to conventional pain relievers.

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