Nerve pain, also known as neuropathic pain or neuropathy, refers to painful sensations around the nerves. Various treatment options are available, including anticonvulsants, certain antidepressants, mild opioids, and some topical treatments.

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Scientists define nerve pain or neuropathy as any condition in which an individual has sustained damage to their nerves.

This article looks at the main types of medications for neuropathy, discussing which have the most positive effects. It also considers what the science has to say about nonpharmacological treatments for this condition.

Research suggests that the prevalence of peripheral neuropathy is about 2.4%, rising to 8% among older adults.

The typical symptoms of neuropathy include:

  • pain near any affected nerves
  • weakness
  • numbness
  • burning or pricking sensations

A wide range of underlying conditions can cause this type of pain.

Learn more about the types and causes of nerve pain.

Anticonvulsants are first-line medications that help manage the symptoms of seizure disorders, such as epilepsy.

As a 2022 review explains, these drugs can work in various ways. One important mechanism of action involves the ion channels, which are cell components that regulate cell function by letting mineral ions in and out.

A 2017 paper suggests that some anticonvulsants are among the most effective medications for neuropathic pain. These first-line neuropathy medications act on specific ion channels that traffic calcium ions. They include gabapentin (Neurontin) and pregabalin (Lyrica).

Although they are often effective, these medications can cause adverse effects.

A 2019 review lists the following possible side effects of both gabapentin and pregabalin:

Gabapentin can also lead to blurred vision, while pregabalin can cause weight gain.

A person should consult a doctor if they notice these symptoms after taking anticonvulsants.

Scientists also consider some antidepressants to be a first-line treatment for neuropathic pain. The most effective antidepressants for neuropathic pain are tricyclic antidepressants (TCAs) and serotonin–noradrenaline reuptake inhibitors (SNRIs).

However, these medications can also produce side effects.

Amitriptyline

Amitriptyline is a TCA that can help people manage nerve pain. However, it can lead to a host of unwanted effects, including:

In rare cases, some people may have serious side effects after taking amitriptyline. These may include:

Duloxetine and venlafaxine

Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor). A 2018 study demonstrated that duloxetine was more effective than venlafaxine in decreasing the symptoms of chemotherapy-induced peripheral neuropathy.

However, these drugs can result in side effects.

Duloxetine can cause:

  • constipation
  • dry mouth
  • difficulties with:
    • balance
    • walking
    • speaking
    • swallowing

The possible side effects of venlafaxine include:

People should speak with a doctor if they are experiencing side effects that are affecting their quality of life.

Experts consider certain opioids to be a second-line treatment option. A 2022 review notes that opioids act on calcium and potassium ion channels to produce pain-reducing effects.

Tramadol (Ultram) and tapentadol (Nucynta) are opioids that can help with neuropathic pain. However, there is evidence that both medications can cause side effects, some of which are serious. These include:

Doctors are less keen to prescribe stronger opioids for neuropathic pain. Stronger opioids for neuropathy include morphine and oxycodone, which cause similar side effects as those above.

Morphine can also lead to dizziness, while oxycodone might induce breathing difficulties. There is also a risk of tolerance, dependence, or misuse, potentially leading to opioid use disorder.

A person should seek immediate medical attention if these drugs are affecting their breathing or causing severe side effects. It is also important to follow the prescription carefully.

Topical treatments are creams, ointments, or patches that individuals can place on their skin. The active components of these products should travel through the skin and into the body, where they will affect the nerves.

The options include lidocaine — a type of local anesthesia — and capsaicin patches.

Lidocaine causes pain relief by acting on sodium ion channels. However, lidocaine patches can cause a rash, erythema, and itching.

Research has also shown that capsaicin, which occurs naturally in chili peppers, acts on both calcium and sodium ion channels. As with lidocaine, capsaicin patches can lead to erythema and itching. In rare cases, they may also cause pain and high blood pressure.

Learn about the best capsaicin creams.

In some cases of neuropathic pain, doctors may recommend that an individual take multiple medications at once. However, the evidence for the effectiveness of combined therapy remains inconclusive.

A 2017 study suggests that certain drug combinations might be useful. For instance, taking an anticonvulsant, such as gabapentin or pregabalin, alongside a TCA antidepressant could be more effective than taking either type of drug alone.

Combining different drugs sometimes provides improved pain relief and tolerability.

However, sufficient evidence has not yet emerged to confirm that combination therapy is more effective than monotherapies.

Despite medical advances, pharmacological treatments for neuropathic pain may only be effective in less than 50% of cases. Therefore, many people seek alternative sources of treatment for this condition.

There is limited evidence that nonpharmaceuticals are helpful in this regard.

However, a recent treatment overview suggests that spinal cord stimulation (SCS) therapy could relieve nerve pain in cases where pharmaceutical treatments have proven ineffective. SCS therapy involves stimulating a person’s spinal cord with electrical impulses. Doctors achieve this by inserting small electrodes into the spine, using either surgery or an epidural needle.

Doctors may prescribe various medical treatments for nerve pain, including antidepressants, anticonvulsants, opioids, and topical medications.

In some cases, they may recommend multiple treatments at once. However, the existing research has not determined whether it is more effective than a single treatment.