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Nerve Pain Medication

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 6 minutes read
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Nerve pain occurs when a nerve becomes pinched, inflamed, irritated or damaged in some way and it alerts your brain that there is a problem in a part of the body, which is helpful at the beginning of an injury to get you to rest up and recover. However, in some cases, a pain nerve may continue to fire even without an injury (or if an injury has healed), and so may cause a longstanding pain condition that you need to learn to manage. Also known as neuropathic pain, it’s usually more complex in its nature than muscle or joint pain and so can be more difficult to treat effectively.

Doctor’s advice

Which painkiller should I start with?

Neuropathic pain can really cut to the core and make your life miserable – people describe intense burning, stinging, tingling, pins and needles, and or that it feels like a stabbing, shooting or electric pain. Common conditions can be:

For those with just mild or brief pain, it’s best to start with the mildest painkillers, such as paracetamol or ibuprofen tablets, and you can get these from a pharmacist or supermarket so you don’t need a prescription for these. Ibuprofen is a anti-inflammatory (NSAID), so has the edge over paracetamol for an inflamed nerve, such as in sciatica or a trapped nerve in the neck. Codeine is also an option, but for higher doses, this needs to be prescribed by your doctor. As all three of these belong to different classes of medications, you can combine them to increase their effect.

Codeine belongs to the opioid class of painkillers – a stronger version is tramadol but this should only be used in the very short term as it can cause addiction and tolerance when used regularly.

Which painkiller comes next?

If paracetamol and ibuprofen are only having a minimal impact on the pain, or you’re needing a long term solution, or medication side effects or risks are not acceptable, your doctor may move you on to medications that specifically target nerve pain. These are only available by prescription and seem to block the neurotransmitter that activates the pain pathway.

Some are used in other circumstances to treat depression and anxiety but don’t worry when you read this on the label as your doctor is using it for pain relief and not for mental health issues. Amitriptyline is the oldest neuropathic painkiller and is a tricyclic antidepressant also used for headaches and depression. It’s very effective in some people, especially for pain at night but it can also make you feel drowsy, dizzy, groggy and sluggish, which, particularly at higher doses, you may be unable to tolerate. Nortriptyline is a similar type of treatment that has fewer side effects. All types of tricyclic antidepressants may take 2-3 weeks to start to reduce pain levels although some people can feel the benefit soon after starting to take them.

Gabapentin is an anti-epileptic medication sometimes used as an alternative as it is less sleep-inducing, but at higher doses may make you feel groggy or weak. It also treats epilepsy, headaches and anxiety, but seems better tolerated than amitriptyline. Pregabalin is a newer version with fewer side effects, but this is only usually given if the others have failed.

Duloxetine is a type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI) that has been found to be helpful in treating neuropathic pain, especially the pain linked to diabetes. It often causes less sleepiness than older antidepressants but may cause constipation, dry eyes and nausea, although these may clear after a couple of weeks of use. It is also used to treat depression and bladder control in women.

These neuropathic painkillers have a cumulative effect, meaning you need to take them regularly for a week or two until you see results, and build up the dose gradually until effective. Higher doses often bring more side effects, though, so this may be a play-off against effective pain relief, and you should always be cautious if you feel drowsy and you drive or operate heavy machinery.

You then continue them regularly to keep pain under control. You will have regular reviews with your doctor about changes to the dose and when to gradually reduce it once you feel better.

Any options other than medication?

Absolutely! You can try things to put on the area that help to distract the nerves away from pain, such as a transcutaneous electrical stimulation (TENS) machine which is helpful for lower back pain, where it directs a mild electrical current to a particular area. Medicated pain relief gels or creams such as those containing diclofenac, ibuprofen or aspirin, are less likely to help, but capsaicin cream has been reported to ease mild nerve pain as it contains chilli, delivering a kind of heat to the area that can block pain messages to the brain.

There is some evidence that acupuncture can be effective in pain relief, and, while we don’t fully understand how it works, it can deliver lasting results.

Gentle moving and stretching can help to ease pain, such as stretching out the hamstring muscles at the back of the thigh once you’re over the first few days of sciatica. Once you’re feeling much better, strength and conditioning training can help prevent future nerve problems in a particular area. A physiotherapist will be able to show you targeted exercises.

I’m finding it unbearable, what can I do?

It’s helpful to set your expectations and this may be that you simply aim to achieve a level of comfort rather than be pain-free. Chronic pain can be a debilitating condition, and because the mind and body are linked and the cycle of pain, fear of pain, and avoidance of pain becomes more complex with time, it’s important to address all aspects rather than just seeking the best painkiller or taking more and more of them. This may include psychological therapies or distraction and relaxation techniques, alongside non-medicated options and gentle movements.

If your pain is poorly controlled despite trying different painkillers, and it’s having a significant impact on your working or home life, your doctor may refer you to a speciality relevant to your condition or to a specialist pain service.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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