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Nerve pain medication

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 4 minutes read
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Nerve pain occurs when a nerve becomes pinched, inflamed, or damaged. 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. But over time, it continues to fire even without an injury, and it becomes unhelpful.

Depending on the cause, it can take some time to recover, or it may develop into a longstanding condition you must learn to manage. Also known as neuropathic pain, it’s usually more complex in its nature than muscle or joint pain. Therefore, it’s more difficult to treat effectively.

Doctor’s advice

Which painkiller should I start with?

Nerve pain can cut to the core and gnaw away at you – people describe intense burning, stinging, tingling, pins and needles, and/or it feels like a stabbing, shooting, or electric pain. Common conditions can be shingles or after your shingles rash has cleared (post-herpetic neuralgia), sciatica, multiple sclerosis, fibromyalgia, a slipped disk pressing on a nerve, or diabetic neuropathy.

For those with mild or brief pain, it’s best to start with the mildest painkillers, such as acetaminophen or ibuprofen tablets; you don’t need a prescription for these. Ibuprofen is an anti-inflammatory, so it has the edge over acetaminophen for an inflamed nerve, such as in sciatica or a trapped nerve in the neck. As both of these belong to different classes of medications, you can combine them to increase their effectiveness.

Codeine belongs to the opioid class of painkillers – a stronger version is tramadol, but this is only for short-term relief, as it can cause addiction and tolerance in the long term. Opioids are only available with a doctor’s prescription.

Which painkiller comes next?

If acetaminophen and ibuprofen have only minimal effect, or you’re needing a long-term solution, or 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, your doctor is using it for pain relief, not depression treatment.

Amitriptyline is the oldest neuropathic painkiller used for headaches and depression. It’s very effective in some people, especially for pain at night. But it can make you feel drowsy, dizzy, groggy, and sluggish, which, particularly at higher doses, you may be unable to tolerate. Nortriptyline is another type that has fewer side effects.

Gabapentin is an alternative that is usually 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.

Duloxetine is an alternative that causes less sleepiness but may cause constipation, dry eyes, and nausea, although these may clear after a couple of weeks of use. It also treats 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, so this may be a trade-off against effective pain relief. And you should be cautious if you feel drowsy and you drive or operate heavy machinery.

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

Any options other than oral medication?

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

Acupuncture has good evidence for its effect on many types of 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. This may be that you aim to achieve a level of comfort rather than be pain-free. Pain can be a debilitating condition, and as mind and body are invariably 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. This may include psychological therapies, distraction and relaxation techniques, non-medicated options, and gentle movements.

Suppose your pain is poorly controlled despite trying different painkillers, and it significantly impacts your working or home life. In that case, your doctor may refer you to a specialty relevant to your condition or a specialist pain service.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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