Neuropathic Pain Diagnosis
A doctor will interview you and perform a physical exam to determine whether you have neuropathic pain. They might inquire as to how you would describe your discomfort, when it happens, or whether something in particular set it off. Your neuropathic pain risk factors will also be discussed with the doctor, who may also order blood and nerve tests.
Neuropathic Pain Treatment
Drugs that prevent seizures and alleviate depression are frequently used as initial treatments. Non-steroidal anti-inflammatory medicines (NSAIDs), such as Aleve or Motrin, may reduce pain, according to several neuropathic pain studies. A stronger painkiller can be necessary for some persons. Talk to your doctor about the benefits and drawbacks of the medications you take.
If another ailment, such as diabetes, is present, improved control of that condition may reduce the discomfort. Further nerve damage can be avoided with proper therapy of the disorder.
The pain expert may employ an invasive or implantable device to successfully manage the pain in cases that are challenging to treat. Electrical stimulation of the neuropathic pain-related nerves has the potential to considerably reduce pain symptoms.
Neuropathic pain can benefit from various other types of therapy as well. A few of these are:
- Physical exercise
- working with a therapist
- relaxation training
- massage treatment
Anti-seizure medication or antidepressants may be prescribed by your pain expert, but this does not necessarily indicate that you have seizures or are sad. However, it is true that despair or anxiety can exacerbate chronic pain.
However, the pain may be managed using nerve blocks administered by pain experts, such as steroid, local anesthetic, or other medication injections into the afflicted nerves. Spinal cord stimulation, peripheral nerve stimulation, and brain stimulation can all be used to treat neuropathic pain that has not responded to the aforementioned treatments.
For neuropathic pain, the following antidepressant classes are frequently prescribed:
- Tricyclic antidepressants are used to treat central post-stroke pain, shingles, and diabetic neuropathy. Amitriptyline (trade names Amitril, Elavil), imipramine (trade names Tofranil), nortriptyline (trade names Aventyl, Pamelor), and desipramine are some of these drugs (brand name Norpramin). The term "tricyclic" refers to the chemical makeup of the medicine.
- Duloxetine (trade names: Cymbalta) and venlafaxine (trade names: Effexor) are serotonin-norepinephrine reuptake inhibitors (SNRIs) used to alleviate diabetic neuropathy pain. The pain associated with polyneuropathies can also be relieved with venlafaxine extended-release.
- Combination therapy. For some people, combination therapy is effective. One such treatment combines aspects of an opioid and an antidepressant and is called tapentadol (trade name Nucynta). Studies have revealed that it differs from the opioid oxycodone in certain positive ways.
- Selective Serotonin Reuptake Inhibitors (SSRIs). This class of drugs isn't normally the first option on its own, but it might be useful in conjunction with tricyclic antidepressants or if other drugs aren't well tolerated. Escitalopram (brand name Lexapro), paroxetine (brand names Brisdelle, Paxil, and others), and fluoxetine are alternatives (brand names Prozac, Sarafem, and others).
Antidepressant dangers and side effects may include, but are not limited to: constipation, weight gain, dry mouth, nausea, drowsiness, and lightheadedness. Suicidal thoughts may also be more likely when taking antidepressants. Before taking antidepressants or any other medicine while pregnant, women should consult their doctor.
Topical therapies, which are frequently offered as a patch, gel, or lotion, might be beneficial for localized neuropathic pain. These items contain medication that is absorbed into the skin and either numbs the area or reduces discomfort.
For those who can't take oral medication well or would rather not, topical therapies could be a useful alternative. Cognitive negative effects are prevented because little of the medicine enters the bloodstream. To significantly reduce pain, usually several applications are required.
Topical treatments that are frequently used include lidocaine (marketed as Lidoderm, Xylocaine, and others) and capsaicin (marketed as Zostrix, Trixaicin, and others).
The most frequent adverse effects are flushing of the face as well as swelling, burning, and other irritability in the region where the medicine is applied. Cough, chest tightness/wheezing, and breathing issues are just a few of the less frequent adverse effects.
Opioids can be beneficial in some circumstances, but they are frequently discouraged due to worries about overdoses, abuse, dependence, and the consequences of prolonged usage. Opioids must to be used in high doses to effectively treat neuropathic disorders' pain.
Opioids such as oxycodone (brand names Oxecta, OxyContin), morphine (brand names MS Contin, Kadian, and others), and tramadol (brand names Ultra, Conzip, and others) are used to treat polyneuropathy, phantom limb pain, and diabetic peripheral neuropathy. Pain that lingers after a limb has been severed is known as phantom limb pain.
Some patients stop using opioids because of its risks and side effects, including sleepiness, constipation, nausea, and vomiting. Additionally, there is a chance of having serious breathing issues, which, when mixed with alcohol or another sedative, can be fatal. Pregnancy is not a time to consume opioids.
The various types of neuropathic pain may be reduced with the aid of additional drugs. Corticosteroids, such as prednisone, can aid with severe pain brought on by nerve irritation and inflammation.
In addition to being taken orally, neuropathic pain medications may also be administered intravenously, via an implanted pain pump, topically, or as a patch.