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Medication can help relieve pain symptoms, as well as improve sleep and quality of life, but it wont reverse or cure neuropathy, Dr. Williams says.

Common over-the-counter medication that people reach for to address mild to moderate neuropathic pain includesTylenol (acetaminophen),nonsteroidal inflammatory drugs (NSAIDs)such as Advil (ibuprofen) and Aleve (naproxen),and topical treatments such as capsaicin and lidocaine creams. Prescription medication such as COX-2 inhibitors likeCelebrex (celecoxib), opioids, and Ultram (tramadol) can be taken as well. (22)

Patients can get a measure of relief from such traditional, nonspecific medication, he says. But they are more likely to gain relief from certain categories of medication that have a specific effect on the pain pathways. They act on pain from abnormal nerve firing or nerve signals.

Williams says antidepressant, antiseizure, and antiepileptic medications are the types of categories were likely to turn to and can be most helpful.

Antidepressants have an effect on some of the neurotransmitters like norepinephrine and serotonin, which can have an effect on pain, he explains. Among the options in this category of treatment are selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Zoloft (sertraline), which restore the chemical balance in the nerve cells of the brain; serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and Effexor (venlafaxine), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrine; norepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrine; and serotonin receptor modulators, such as Oleptro (trazodone), which increase the levels of serotonin and norepinephrine in the brain available to transmit signals to other nerves.

Williams says the effectiveness of anticonvulsants is still being investigated, but we believe the mechanism of effect is on calcium channels, and that can reduce transmission of those abnormal nerve signals, often within the peripheral nerve or the spinal cord. Gabapentin is an example of an anticonvulsant thats used to relieve nerve pain in people who have had shingles or have diabetes. (23,24)

There are other treatments that act more directly on nerves, such as neuromodulation or surgery. Neuromodulation can involve placing an electrode along a peripheral nerve. These are helpful by essentially turning off pain signals, explains Williams. You can do that very selectively with individual peripheral nerves or you can take a more regional approach with spinal cord stimulation.

Surgery can be useful to release pressure on a nerve, says Peter Highlander, DPM, a podiatrist based in Sandusky, Ohio.Its a technique more commonly used to treat the pain of carpal tunnel syndrome, but it can also be used to treat diabetic neuropathy. (25,26)

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Neuropathy: Symptoms, Causes, Types, Treatment, Nutrition ...

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