Nerve Pain Options 101: It can be a pain to choose

Some people report a shooting sensation; a stabbing pain; a burning tingle. For others, the lightest brush of a feather against their skin might cause them to howl in agony.

The way that nerve pain (also known as neuropathic pain) feels can vary wildly between different people. There are also many different conditions that can cause nerve pain in the first place, including diabetes, shingles, chemotherapy, and a herniated disk.

Unfortunately, this type of pain can also be notoriously difficult to treat. But that doesn’t mean you don’t have options—there are a wide variety of prescription medications that can help dull the sensations and control your symptoms. 

It can be a trial and error process to find the right option for you, and sometimes that journey can feel intimidating and overwhelming. That’s why below our pharmacists set out to break down all of the different types of medications you can take.

Anticonvulsants

As the name implies, anticonvulsants are a family of prescription medications that were originally created to help control seizures in patients with epilepsy. However, since their creation, they have become a popular first-choice treatment for nerve pain as well. This is because these drugs focus on the nervous system, where they stop the transmission of pain signals from damaged nerves. 

These medications might take several weeks until they start to affect your pain levels. Some examples are carbamazepine (Tegretol), oxcarbazepine (Trileptal), lamotrigine (Lamictal), phenytoin (Dilantin), pregabalin (Lyrica), gabapentin (Neurontin), and valproic acid (Depakene). 

Some pharmacist tips: 

  • Avoid driving or doing other tasks that require you to be alert until you see how this drug affects you. 
  • Talk with your doctor before you use alcohol, marijuana, or other forms of cannabis, or prescription or over the counter drugs that may slow your actions. 
  • It’s very important that you do not stop taking this medication all of a sudden without calling your doctor. You may have a greater risk of having a seizure. If you need to stop this medication, you will need to taper down slowly as instructed by your doctor. 
  • If you discover that you are pregnant let your doctor know right away as this drug may not work as well to control seizures during pregnancy. 
  • In extended-release tablet formulations, you may see something that looks like the tablet in your stool. This is normal!  If you have questions, talk with your pharmacist or doctor. 

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Antidepressants

Antidepressants are typically prescribed to treat depression, but they have also become a popular choice for nerve pain as well. Many combination therapies for nerve pain are a mix of antidepressants and anticonvulsants. Like anticonvulsants, antidepressants can take a few weeks before they start to help with nerve pain.

There are two main types: tricyclic antidepressants and SNRIs (serotonin and norepinephrine reuptake inhibitors). Tricyclic antidepressants are an older class of medications that are now more commonly used for nerve pain than depression. By contrast, SNRIs are a newer family of antidepressants. They have fewer side effects; however, they are also less effective. 

Examples of these medications include: 

The benefit of antidepressants is that they treat depression and nerve pain. This can be helpful since chronic pain can lead to depression, and depression can lead to worse pain. If you want to learn more about this mind-body connection, check out our article here. 

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Some pharmacist tips: 

  • These medications should not be stopped suddenly without calling your doctor. You may be at greater risk of side effects if you stop this drug suddenly rather than slowly stopping overtime as directed by your doctor. 
  • Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.
  • To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful about going up and downstairs.

Topical treatments

Topical treatments for nerve pain are prescription medications applied to and absorbed through the skin. They are typically prescribed for small, localized areas of pain, and they come in various forms such as pain killing gels and lidocaine patches. Some examples include Diclofenac Topical Gel (Solaraze), lidocaine patches (Lidoderm), or Lidocaine Topical Ointment (Xylocaine). 

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Prescription NSAIDs (nonsteroidal anti-inflammatory drugs)

These medications are common over-the-counter forms of pain relief. However, when the OTC form is not strong enough, your doctor may prescribe a prescription form of the NSAID at a greater strength. Some options can include celecoxib (Celebrex), meloxicam (Mobic), piroxicam (Feldene), sulindac (Clinoril), ketorolac (Toradol), and diclofenac (Voltaren)

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Opioid painkillers

These medications are reserved for short-term relief of severe nerve pain. They work by diminishing the pain signals from your nervous system by mimicking the pain-relieving endorphins made by your brain. However, over time your body will develop a tolerance to these medications and their effect will lessen. 

Some examples include hydrocodone (Hysingla ER), hydrocodone-acetaminophen (Norco, Zyfrel), fentanyl (Actiq, Fentora), oxycodone (OxyContin, Roxicodone), and oxycodone-acetaminophen (Percocet, Roxicet). They are typically avoided if possible due to the risk of addiction and abuse. 

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Dr. Jessica Nouhavandi

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