More medicines used to treat neuropathic pain
Anti-epileptic medicines (anticonvulsants)
An anti-epileptic medicine is an alternative to an antidepressant. For example, gabapentin, pregabalin, sodium valproate, and carbamazepine. These medicines are commonly used to treat epilepsy but they have also been found to ease nerve pain. An anti-epileptic medicine can stop nerve impulses causing pains separate to its action on preventing epileptic seizures. As with antidepressants, a low dose is usually started at first and built up gradually if needed. It may take several weeks for maximum effect as the dose is gradually increased.
Sometimes both an antidepressant and an anti-epileptic medicine are taken if either alone does not work very well. Sometimes a traditional painkiller such as codeine is combined with an antidepressant or an anti-epileptic medicine. As they work in different ways they may compliment each other and have an additive effect on easing pain better than either alone.
Opiates and similar painkillers
Opiates painkillers are the stronger 'traditional' painkillers. For example, codeine, morphine and related drugs. Another painkiller called tramadol is similar but has a distinct method of action that is different to opiate painkillers. Opiates and tramadol tend to be good at treating non-neuropathic pain. They also have a role in treating neuropathic pain, but may be less effective than in treating non-neuropathic pain. Also, there is a risk of problems of drug dependence, impaired mental functioning and other side effects with the long-term use of opiates. In general, opiates and tramadol tend to be used mainly if there are problems or side-effects with using antidepressant or anti-epileptic drugs. A recent research review concluded that tramadol in particular may be a good option for neuropathic pain in certain situations.
Combinations of medicines
Sometimes both an antidepressant and an anti-epileptic medicine are taken if either alone does not work very well. Sometimes an opiate such as codeine is combined with an antidepressant or an anti-epileptic medicine. As they work in different ways they may compliment each other and have an additive effect on easing pain better than either alone.
Capsaicin cream
This is sometimes used to ease pain if the above medicines do not help, or cannot be used because of problems or side-effects. Capsaicin is thought to work by blocking nerves from sending pain messages. Capsaicin cream is applied 3-4 times a day. It can take up to 10 days for a good pain relieving effect to occur.
Capsaicin can cause an intense burning feeling when it is applied. In particular, if it is used less than 3-4 times a day, or if it is applied just after taking a hot bath or shower. However, this side-effect tends to ease off with regular use. Capsaicin cream should not be applied to broken or inflamed skin. Wash your hands immediately after applying capsaicin cream.
Other medecines
Some other medicines are sometimes used on the advice of a specialist in a pain clinic. These may be an option if the above medicines do not help.
For example, ketamine injections. Ketamine is normally used as an anaesthetic, but at low doses can have a pain relieving effect. Another example is lidocaine (lignocaine) gel. This is applied to skin with a special 'patch'. It is sometimes used for postherpetic (post shingles) neuralgia (but note, it needs to be put onto non-irritated or healed skin).
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