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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Pain

Neuropathic Pain (5878)

Neuropathic Pain (5878) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Pain

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Neuropathic Pain
When nerves are hurt or do not work the way they should, they can cause “neuropathic” pain.
Neuropathic pain is often described as intense, burning, tingling, shooting, or feeling like electric
shocks. The pain can be constant or it can come and go. Some people may have numbness,
tingling, and pricking sensations, hot or cold sensations, sensitivity to touch, or muscle
weakness. Some people report feeling numbness and pain at the same time. Sometimes,
something as simple as a light touch, cold, or even taking a shower can result in severe pain.

This handout explains some of the treatments for this type of pain. If you have questions or
concerns about your pain and its treatment or want more information, check with your health
care provider, nurse, or pharmacist.

Treatment
We do not yet know how to heal damaged nerves, so neuropathic pain is hard to treat. Treatment
is centered on reducing pain and improving function so you can have a good quality of life.
Effective treatment most often requires a blend of medicines, exercise, and other therapies. It
can take some time to find the combination that is right for you.

Medicines
Your provider may prescribe one or more medicines for you. See below for examples of
commonly used medicines. Most medicines used for neuropathic pain work by helping to
“calm” the nervous system and reduce the pain.

Anticonvulsants: Anticonvulsant medicines are mainly used to treat seizures. Certain of these
have been found to reduce neuropathic pain. These include:

 gabapentin (Neurontin®)
 pregabalin (Lyrica®)
 carbamazepine (Tegretol®)
 topiramate (Topamax®)
 lamotrigine (Lamictal®)
 zonisamide (Zonegran®)
 others

Antidepressants: Some drugs used to treat depression may also reduce pain and help you sleep
even if you do not have depression. These include:

 amitriptyline (Elavil®)
 desipramine (Norpramin®)
 duloxetine (Cymbalta®)
 milnacipran (Savella®)
 nortriptyline (Pamelor®)
 trazodone (Desyrel®)
 venlafaxine (Effexor®)
 others


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Local Anesthetics: These medicines reduce pain by blocking electrical signals in nerves.
Different anesthetics can be given on the skin as creams, ointments or patches, as injections or by
mouth. These include:

 lidocaine (Xylocaine or Lidoderm®)
 mexiletine (Mexitil®)
 bupivacaine (Marcaine®)

Opioids (narcotics): Opioids may be useful for some patients with neuropathic pain. For more
information about opioids, ask your doctor or nurse or request a copy of Health Facts for You
#4659 (Opioid Analgesics).

Steroids: Steroids may be used short-term to help reduce inflammation, swelling, and pain.
They may be injected, applied to the skin, or taken by mouth. Because of side effects (ask your
doctor or nurse) they must be used cautiously.

Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs reduce inflammation and relieve
certain types of pain but are generally not helpful for neuropathic pain alone. If you have other
kinds of pain along with neuropathic pain, your provider may suggest taking NSAIDs by mouth
or placing them on the skin as creams, sprays or patches.

Advice on Taking Medicines for Neuropathic Pain
If your doctor starts you on a medicine for neuropathic pain, you most often will start with a low
dose of the medicine. You will slowly increase the dose until you either have pain relief or
decide that the drug does not work for you. Many of these drugs may not have much effect in a
single dose. You must take them regularly over many weeks before you know if they will work
for you. Be sure to take them exactly as prescribed. Ask your provider if you have any
questions about using them.

Side effects vary from drug to drug. Most of them can cause drowsiness, lightheadedness, or
dizziness. These effects usually fade as you become used to the drug. For information on other
side effects, talk to your health care team or pharmacist.

Some drugs require blood tests every so often to check the level of the drug in your blood. Your
provider will give you instructions if you need to have your levels checked.

If one drug does not work, don’t panic! There are others that may work for you. If you need to
stop a medicine, don’t just stop taking it suddenly. Ask your provider for instructions on how to
safely taper off the medicine.

Lifestyle Changes
If you have neuropathic pain, it is important not to smoke. Smoking can irritate your nerves and
decrease their supply of oxygen, worsening your pain. Ask your health care team if you need
help to stop smoking, or call the Wisconsin Tobacco Quit Line at 1-800-QUIT-NOW.

Frequent use of alcohol can also damage nerves and worsen your pain. If you drink alcohol
frequently, talk to your provider or nurse about a plan to help you decrease or stop using alcohol.




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Other Treatments
Your regular provider may treat your pain or you may be referred to a pain specialist or pain
center. Pain centers focus on pain treatment with a staff of doctors, advanced practice providers,
nurses, therapists, and medical professionals who are experts in pain management. These centers
most often offer a variety of treatments and they treat all types of pain, including neuropathic
pain.

Pain centers work with you to improve your ability to function physically and emotionally as
well as reduce your pain.

Treatments at pain centers may include:

Exercise Some exercises can help improve lost motion, increase strength, and
reduce pain. Physical therapists (PTs) and occupational therapists
(OTs) will prescribe specific exercises for your problem.
Strengthening, weight bearing, and range-of-motion exercises can
help. “Desensitization” exercises use skin stimulation to help your
skin get used to contact. Desensitization can help you more easily
deal with the touch of clothing, bed sheets, or other objects.

Modalities Therapists may also use treatments like heat or cold, massage, or
electrical stimulation. TENS is a type of electrical therapy designed
to reduce pain by applying a mild electrical stimulus to your skin.

Behavioral Treatment The stress of dealing with neuropathic pain can be very high. It is
helpful to learn how to cope with and adapt to your pain. Health
psychologists are experts in treatments including counseling,
biofeedback, relaxation training, and other stress-reducing therapies.

Injections When your providers know the specific nerve or nerves causing the
pain, injections of local anesthetics, steroids, and/or other agents can
sometimes give you relief. Not everyone with neuropathic pain will
benefit from injection therapy. Ask your provider or nurse for more
information.













Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©1/2015 University of Wisconsin Hospitals and
Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5878.