Various medications have been used in an attempt to treat neuropathic pain. The majority of these medications are used off-label, meaning that the medication was approved by the Food and drug administration (FDA) to treat other conditions and was then identified as being beneficial to treat neuropathic pain.
Pregabalin successfully alleviates the symptoms of various types of neuropathic pain and presents itself as a first line therapeutic agent with remarkable safety and efficacy.
Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine) have been prescribed for control of neuropathic pain for many years but are associated with multiple side effects.
Selective serotonin reuptake inhibitors (SSRIs like paroxetine and citalopram) and other antidepressants (venlafaxine, bupropion) have been used in some patients.
Another common treatment of neuropathic pain includes antiseizure medications (carbamazepine, phenytoin, gabapentin, lamotrigine, and others).
In severe cases of painful neuropathy which don’t respond to first-line agents, medications typically used to treat heart arrhythmias may be of some benefit; however, these can lead to significant side effects and must be monitored closely.
Medications applied directly to the skin can provide modest to pronounced benefit for some patients. The forms commonly used include lidocaine (in patch or gel form) or capsaicin.
Multiple arguments have been made both promoting and vilifying the use of narcotic agents to treat chronic neuropathic pain. No specific recommendations regarding the use of narcotics will be made at this time.
Curing neuropathic pain is dependent on the underlying cause. If the cause is reversible, then the peripheral nerves may regenerate and the pain will abate; however, this reduction in pain may take many months to years.