Treatments for neuropathic pain

Choosing pain medications wisely

There are different types of medications available for the treatment of neuropathic pain. The Canadian Pain Society (CPS), which is made up of about 650 healthcare professionals across Canada, developed guidelines in 2007 for doctors to follow when prescribing medications for the treatment of neuropathic pain.

Prescription pain medications recommended by the Canadian Pain Society for the treatment of neuropathic pain

The following prescription medications are authorized in Canada for the treatment of neuropathic pain:

Pregabalin (^PrLyrica^®) can provide relief of neuropathic pain in people with diabetes (diabetic peripheral neuropathy), in those who have suffered from shingles (postherpetic neuralgia), and may be useful in the management of central neuropathic pain, for which it has been authorized by Health Canada with conditions, which is a form of market authorization granted based on promising evidence of clinical effectiveness. With pregabalin, the most common side effects were dizziness, somnolence, swollen extremities (peripheral edema), dry mouth, blurred vision and weight gain.

Carbamazepine (^PrTegretol^®) can provide relief of neuropathic pain caused by trigeminal neuralgia, a disease of the facial nerves. It should only be used during flare-ups (exacerbations) of trigeminal neuralgia, and should not be used to prevent the return of symptoms during periods where people are pain-free. With carbamazepine, the most common side effects were drowsiness, headache, unsteadiness on the feet, double vision, dizziness, nausea, vomiting, as well as allergic reactions.

Delta-9-tetrahydrocannabinol (THC) — cannabidiol (CBD) (^PrSativex^®) is a narcotic drug that may be useful as an addition to other drugs for the relief of neuropathic pain caused by multiple sclerosis. THC, one of the active components of this drug, can produce physical and psychological dependence and has the potential for being abused. With this product, the most common side effects were dizziness, fatigue, nausea, dry mouth, somnolence, and diarrhea. The drug is taken as a spray to be applied inside the mouth.

Duloxetine (^PrCymbalta™) can provide relief of neuropathic pain in people with diabetes (diabetic peripheral neuropathy). With duloxetine, the most common side effects were nausea, somnolence, fatigue, headache, dizziness, diarrhea, decreased appetite, constipation, insomnia and excessive sweating.

Some types of neuropathic pain are relieved by treating the underlying condition that is causing them. For example, pain due to a nutritional deficiency can be treated with nutritional supplements. Diabetes patients can reduce their neuropathic complications by getting their blood sugar levels under control.

Proper exercise, diet, alternative therapies and relaxation techniques, along with the prescribed treatment, can help manage neuropathic pain. A doctor may also recommend surgery, electrical nerve stimulation, or physiotherapy to relieve neuropathic pain.

Over-the-counter pain medications

Neuropathic pain is generally not relieved by pain medications available without a prescription (over the counter).

However, ASA (Aspirin^®) lists neuralgia (nerve pain) among the variety of conditions for which it can relieve pain. With ASA, the most common side effects were nausea, vomiting, diarrhea, gastrointestinal bleeding or ulceration, ringing in the ears (tinnitus), and skin rash (urticaria).

A cream containing capsaicin (Zostrix^®), another drug that can be obtained without a prescription, may also be used to relieve neuropathic pain following episodes of shingles (after lesions have healed) or associated with diabetes (diabetic peripheral neuropathy). Local irritation, including a burning sensation, can occur with capsaicin; therefore, the cream should not be used on broken or irritated skin. Contact with eyes should also be avoided.

1. Lyrica is a registered trademark of C.P. Pharmaceuticals International C.V., Pfizer Canada Inc., Licensee
2. Tegretol is a registered trademark of Novartis Pharmaceuticals Canada Inc.
3. Sativex is a registered trademark of GW Pharma/Bayer Inc.
4. Cymbalta is a trademark of Eli Lilly Canada Inc.
5. Aspirin is a registered trademark of Bayer Consumer Care.
6. Zostrix is a registered trademark of Medicis Pharmaceutical Corporation.