Medications for Nerve Pain
Learn More About Common Pain Conditions, Their Origins, and Mechanisms
Neuropathic pain, also known as nerve pain, is a type of pain characterized by symptoms resulting from nerve damage. Refer to the section ‘Complaints – Nerve Pain’ for more details.
To treat neuropathic pain, various therapeutic options exist, with medication being one of the symptomatic relief methods. Medications used to treat nerve pain are also known as antineuropathic co-analgesics.
Medication for Nerve Pain
A targeted medication approach for nerve pain is considered only when nerve pain is suspected. At the beginning of nerve pain treatment, the expected benefits of the therapy are discussed along with potential side effects. The choice of medication for nerve pain depends on the specific pain problem, previous medical history, existing medications, and comorbid conditions.
It’s important to note that almost all antineuropathic medications are used ‘off-label.’ This means they were not initially developed and approved for pain but for other conditions. During their initial use, they were found to have positive effects on nerve pain.
The following antineuropathic medications are commonly used in pain medicine:
- Tricyclic Antidepressants (TCAs)
- Selective Serotonin and Noradrenaline Reuptake Inhibitors (SSNRIs)
- Antiepileptics
- Treatment Initiation and Dosing
At the start of treatment, a low dose is typically administered and gradually increased over time. The goal is to determine the optimal dose that provides the maximum possible effect with minimal side effects. Sometimes, due to side effects, the dose cannot be increased further. In such cases, the treatment strategy needs to be reassessed, and switching to a different medication may be considered.
A medication-based antineuropathic treatment usually takes some time before the desired effect is achieved. It may take weeks for the pain-relieving effect to manifest. If no effect is observed, the medication is gradually reduced and discontinued.
Intravenous Medication Testing
Intravenous medication testing can be helpful in selecting the appropriate nerve pain medication. This testing evaluates the response of nerve receptors to different drug classes. The pharmacological response to blocking NMDA receptors (via ketamine), sodium channels (via lidocaine), and opioid receptors (via remifentanil) can be assessed to implement the medication treatment more effectively.
Summary
Treating neuropathic pain with medication requires a careful and patient approach. By starting with low doses and gradually increasing, and using intravenous testing to guide drug selection, optimal pain relief can be achieved while minimizing side effects. Understanding and managing these factors are crucial for effective neuropathic pain management.
