Relieving Pain – Current Thoughts on Drug Treatments For Neuropathic Pain

Neuropathic pain results from damage to or dysfunction in the nervous system, triggered by trauma, infections and nervous system disorders. This type of pain is difficult to treat and often requires a combination of pharmacological therapies, psychological counseling and the use of some form of alternative and complementary medicine. In 2007, a study cited in the Journal of Pain estimated that 170 to 270 million people around the world suffer from peripheral neuropathy (e.g., phantom limb syndrome and complex regional pain syndrome) and neuropathic pain.

Neuropathic pain can be described as numbing or burning, plus sensations of tingling, electric shock, crawling, itching, or shooting. Excruciating pain can be caused by even the lightest touch. Mild pain stimuli are perceived as very painful. Pain on one side of the body is also felt on the other side. The area of pain increases to include larger and larger areas of the body.

Common Drug Treatments for Neuropathic Pain

• Antidepressants

Several types of antidepressants have analgesic effects (e.g., SSRI’s, SNRI’s, and TCA’s) and can alleviate pain, but only one, duloxetine, has been approved for pain treatment by the Federal Drug Administration.

• Anticonvulsants

Several anticonvulsants (e.g., gabapentin, pregabalin) are used as standard treatment choices for neuropathic pain, even without definitive studies and in spite of such side effects as dizziness, sleep problems, or fatigue.

• Topical Medications

Topical medications (e.g., capsaicin – the pungent ingredient in hot chili — and lidocaine) work on a small local area of the body, so they do not usually cause systemic side effects and rarely any interaction effects with other drugs. However, if the pain extends to a wider area of the body, topical treatment would not be as effective.

• Opioids

Studies have shown that opioids (e.g., oxydodone and morphine) do alleviate the pain in different neuropathic pain conditions. Common side effects of opioids include sedation, nausea, vomiting, dizziness, and respiratory depression. The long term use of opioids can also lead to physical dependency which should not be confused with physical addiction. Patients who are taking opioids to alleviate pain, if they have a prior history of drug addiction, sometimes find themselves triggered back into their addiction. Those who do not have a history of drug addiction do not first develop such an addiction from being treated with opioids.

• Other Medications

Additional medications often used to treat neuropathic pain include muscle relaxants, antispasmodics, anxiolytics (anti-anxiety, tranquilizers), sedatives-hypnotics, and psychostimulants. Current clinical trials of cannabis-based drugs (drugs containing a substance found in marijuana) indicate potential to alleviate neuopathic pain.

Continuum of Treatments for Neuropathic Pain

In 1990, The World Health Organization established guidelines for the treatment of malignant pain. This approach recommends beginning with the least invasive and the most easily manageable treatments first before attempting more invasive interventions such as pharmaceuticals, neurostimulation or opioid delivery through a reservoir or pump implanted directly inside the patient’s body.

• Exercise
• Meditation and relaxation
• Over-the-counter medications
• Prescribed medications
• Physical rehabilitation
• Cognitive and behavioral therapies
• Oral opioid medications
• Nerve blocking
• Spinal cord stimulation
• Intraspinally administered opioids
• Tissue destruction procedures

Complementary and Alternative Treatments for Neuropathic Pain

Many methods considered complementary and alternative healing modalities are not mentioned in the above list. Treatments that may have profound healing and pain relieving possibilities include the following.

• Mind-body awareness, mindfulness, guided imagery and visualization
• Breath work
• Body therapy (e.g., massage, acupressure, acupuncture, Therapeutic Touch, etc.)
• Somatic Body Psychotheapy
• Expressive arts and movement therapies
• Diet and herbs and homeopathic remedies
• Aromatherapy

If you are currently suffering from neuropathic pain or chronic pain from another cause, it may be worth your while to at least check out some of the methods listed above before subjecting your body to more invasive treatments.