Depending on the cause, nerve pain can become chronic, but there are many mediation options that can help.
Nerve pain, also known as neuropathic pain, can come in various forms, from stabbing and shooting sensations to feelings of burning or tingling.
There are a variety of medications that can help with nerve pain. The best option for you will depend on both the severity and underlying cause of your pain.
Both over-the-counter (OTC) and prescription drugs can aid in easing nerve pain symptoms. However, before taking any medications, it’s vital to speak with a doctor or healthcare professional.
“Not all medications are suitable for young people. Some anticonvulsants, for example, shouldn’t be taken by people under 18,” says Jacob Hascalovici, PhD, chief medical officer at Clearing. “Pregnant people should also double-check their medications and make sure their medical team is informed.”
Some pain medications (such as gabapentin and pregabalin) “should be used with caution in elderly people,” adds Farah Khorassani, PharmD,health sciences associate clinical professor at the University of California, Irvine School of Pharmacy & Pharmaceutical Sciences.
“This is because they can increase the risk of falls,” she notes.
OTC medications may be easier to obtain but are generally better suited for milder cases of nerve pain.
“These drugs can relieve occasional, mild nerve pain but do not work as well for severe, persistent pain,” says Dr. Akanksha Sharma, board certified neurologist and neuro-oncologist at the Pacific Neuroscience Institute in Santa Monica, California.
This is especially the case, she adds, “when the pain is electrical, burning, tingling, or ‘shock-like’ in nature.”
Oral pain relievers
OTC pain relievers include the following:
- acetaminophen (Tylenol)
- ibuprofen (Advil)
- naproxen (Aleve)
These work quickly, often within 20 to 30 minutes, but their effects wear off after a few hours, notes Sharma.
Creams and patches
Capsaicin is a potent “enzyme found in chili peppers, which acts as a pain reliever,” Khorassani says.
The enzyme works by disrupting pain signals sent to the brain and, as such, is often combined into OTC creams and patches. The potency of capsaicin in OTC formulations is relatively low, at less than 1%, meaning it’s not considered particularly beneficial for treating severe neuropathy.
Lidocaine is another medication that comes in a cream or patch form (it also has OTC and prescription forms) that can be used for the treatment of nerve pain. The 5% Lidocaine patch
“Certain supplements have been demonstrated to have some limited benefit with nerve pain, mainly alpha-lipoic acid and B12, although the latter is mainly helpful when a deficiency has been identified,” notes Sharma.
Research involving more than 200 people with diabetes-related neuropathic pain saw that taking alpha-lipoic acid led to a “significant” lowering in pain levels.
It’s worth noting that supplements aren’t a fast-acting solution. “These will take time to work, at least several weeks of regular intake,” Sharma adds.
Remember to always speak with a doctor before taking any new supplements.
For more severe and persistent cases of nerve pain, stronger prescription drugs will likely be required.
As for the time it takes for these to work, “A good rule of thumb is 1 to 2 weeks after a dose change,” states Khorassani. “Some medications have specific dosing ranges to target neuropathic pain, so if the medication isn’t working, the dose should be evaluated.”
These types of drugs are the ones most commonly used for treating neuropathic pain.
However, Sharma notes they weren’t designed for this purpose. “These were initially developed to control seizures but are successful in dulling nerve pain by modulating the signals sent by the nerves.”
An often-prescribed anticonvulsant is gabapentin, “likely due to its favorable safety profile and low cost,” notes Khorassani.
Its efficacy is significant:
Another popular anticonvulsant for treating nerve pain is pregabalin, which
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
This group of medications is often used to treat depression, thanks to its influence on the brain’s “happy chemical,” serotonin.
But serotonin also has a role in neuropathic pain. In addition to affecting mood, the chemical is known to play a role in pain perception and modulation by the brain.
Thanks to their dual effect, serotonin-norepinephrine reuptake inhibitors (SNRIs) are “often used in people with depression and diabetic peripheral neuropathic pain to target both,” says Khorassani.
Duloxetine is the SNRI most often prescribed for nerve pain. An older
Tricyclic antidepressants (TCAs)
As the name suggests, tricyclic antidepressants (TCAs) were initially designed for mental health conditions such as depression and anxiety but have since been found to ease neuropathy symptoms.
Like SNRIs, “These drugs block the reabsorption of the neurotransmitters serotonin and norepinephrine,” says Sharma. “This, in turn, modulates the pain signals sent from the nerves to the brain.”
Often-prescribed TCAs for nerve pain are nortriptyline and amitriptyline. “These have been around the longest and used to be the gold standard before gabapentin was on the market,” says Khorassani.
An older 2009 study comparing nortriptyline and gabapentin found that each drug offered similar levels of pain reduction.
However, Khorassani notes that TCAs generally aren’t tolerated as well compared with gabapentin, which is why the latter is now the preferred option.
Opioids are considered by some to be effective for nerve pain, but the evidence seems to be mixed. As
However, there are also a number of serious side effects that accompany opioid treatments. If other treatments aren’t working for you, a doctor may suggest a short course of opioids.
Botulinum toxin (BoNT)
Botulinum toxin (BoNT) is one of the last choices used in the treatment of nerve pain, but it has been used in cases where there’s refractory nerve pain that’s resistant to other forms of treatment. BoNT
As with all drugs, those used in relieving nerve pain may cause side effects.
OTC treatment side effects
Especially when taken for long periods at high doses, aspirin and ibuprofen “can contribute to irritation of the gut and ulcer formation or cause gastritis,” says Sharma.
Furthermore, she adds, “Ibuprofen may also cause kidney damage when used too often or too much, (while) aspirin can increase bleeding risk as it inhibits the formation of platelets.” If you’re taking any OTC medication regularly, make sure to talk with a doctor about it so steps can be taken to protect your health. In the United States, excess consumption of acetaminophen while overusing acetaminophen-based drugs, such as combination pain relievers and multisymptom cold remedies, is the
In terms of topical creams, Sharma says they tend to have few side effects unless overused. However, “Capsaicin has to be used carefully, often with gloves on, because it is made from chili peppers, and it may cause irritation of the eyes if inadvertently exposed.”
Prescription medication side effects
According to Sharma, potential side effects of anticonvulsants include:
- drowsiness (which usually improves as one adjusts to the dosing)
- mood fluctuations
- blurry vision
- fluid retention or swelling in feet
- weight gain
Meanwhile, she continues, the possible side effects of both SNRIs and TCAs are very similar:
- dry mouth
- urine retention
- vivid dreams
- changes in appetite
“For side effects that are difficult to tolerate, contact your medical team as soon as you can,” says Hascalovici.
Will nerve pain ever go away entirely?
“Every person’s experience is different,” says Khorassani. “It depends on the cause of the neuropathic pain and how bad it is.”
The outlook for an individual is more promising if the nerve pain is caused by an injury or after lying in a particular position. “We’d expect the nerve pain to be temporary and improve with time, eventually fully resolving,” says Sharma.
However, if the neuropathic pain is because of an ongoing health concern, such as cancer or diabetes, Sharma says it’s far less probable the pain will ever entirely disappear.
“It will likely remain a long-term problem that may fluctuate in severity and have to be managed with medications and other interventions.”
While certain medications effectively lower neuropathic pain, complementary approaches can also be taken.
Hascalovici believes “a multidisciplinary, multimodal treatment approach that treats the body, the mind, and the social well-being of each patient is best.”
For instance, “meditation or cognitive behavioral therapy” can be helpful, he notes.
Acupuncture is another potential option, with people with neuropathy in a
It’s thought that transcutaneous electrical nerve stimulation machines may help lower nerve pain and are “sometimes recommended for diabetes-related neuropathies,” says Hascalovici. However,
Finally, Khorassani notes that yoga may be beneficial, and
Nerve pain can occur because of various reasons and manifests in different forms, from tingling to stabbing sensations.
There are numerous treatment options for neuropathic pain, including OTC, prescription medications, and nonpharmacological approaches.
Some of the most commonly prescribed drugs for nerve pain are gabapentin, pregabalin, and duloxetine. However, these can lead to side effects such as drowsiness, nausea, dizziness, and dry mouth.
Whether the nerve pain will fully disappear depends on its cause and severity. And, as Hascalovici points out, “It’s helpful to realize there is no silver bullet treatment or one-size-fits-all therapeutic approach.”