Peripheral neuropathy - Treatment 

Treatment of peripheral neuropathy 

St John’s wort

Many of the medications discussed on this page can react unpredictably if they are taken in combination with the herbal supplement St John’s wort.

St John’s wort has been widely promoted as a herbal treatment for depression and is available to buy in most health stores without the need for a prescription.

It is strongly recommended that you do not take St John’s wort if you are taking one of the medications described on this page (with the exception of topical lidocaine).

Treatment for peripheral neuropathy will address the underlying cause for the condition, and, if necessary, the symptom of nerve pain.

For example, in cases of diabetic polyneuropathy you may be advised to make lifestyle changes to help control your diabetes, and prevent further nerve damage. These may include:

  • giving up smoking
  • cutting down on your alcohol consumption, or ideally not drinking alcohol at all
  • maintaining a healthy weight, if you are overweight or obese
  • taking plenty of exercise

Neuropathic pain

As well as addressing the underlying causes of peripheral neuropathy, you may also require additional medication to treat the symptoms of nerve pain. The medical term for nerve pain is neuropathic pain.

Unlike most other types of pain, neuropathic pain does not usually respond well to treatment with widely used painkillers, such as paracetamol and ibuprofen. Therefore, alternative medications are usually required.

As many of these medications can cause a wide range of side effects, it may take some time to identify a medication that is right for you.

Therefore, you may need to try a number of the medications described below before you find one that suits you. In some cases, you may need to take a combination of different medications.

Initial treatments

Medications called amitriptyline and pregabalin are the initial treatments for people with neuropathic pain that is not associated with diabetes.

If you have diabetes, you should be offered a medication called duloxetine as your first treatment. If you are unable to take duloxetine for medical reasons (for example, because you have chronic kidney disease) amitriptyline may be used as an alternative.

Amitriptyline

Amitriptyline was originally designed to treat depression, but it has subsequently proved to be effective in treating some cases of neuropathic pain.

If you are prescribed amitriptyline, the lowest possible dose will usually be recommended. If the medication is not effective, your dosage can be gradually increased. This approach will help lower your risk of getting side effects.

Common side effects of amitriptyline include:

  • dry mouth
  • constipation
  • sweating
  • problems passing urine
  • slight blurring of vision
  • drowsiness

If you experience drowsiness or blurred vision, do not drive or operate machinery.

The side effects should ease after 7 to 10 days as your body gets used to the medication. However, if your side effects continue or if they become troublesome, tell your GP because it may be possible to change to a different medication that suits you better.

Some people have reported having thoughts of hurting or killing themselves while taking amitriptyline. If this happens to you, see your GP or go to your nearest hospital immediately.

It may be helpful to tell a close friend or relative that you are taking amitriptyline and ask them to keep an eye out for any changes in your behaviour. Do not drink alcohol when you are taking amitriptyline because the combined effects can make you feel very drowsy.

Pregabalin

Pregabalin can be used as an initial treatment for neuropathic pain if you are unable or unwilling to take amitriptyline. As with amitriptyline, you will be prescribed the lowest possible dose necessary to control your symptoms. If required, the dose can be adjusted.

The two most common side effects of pregabalin are:

  • dizziness
  • tiredness

Do not drive if you experience these side effects.

Duloxetine

Duloxetine was originally designed to treat severe depression, but it has proved to be effective in treating neuropathic pain associated with diabetic polyneuropathy.

As with amitriptyline, there have been reports of people suddenly having thoughts of hurting or killing themselves after taking duloxetine. See your GP or go to your nearest hospital immediately if you experience such thoughts.

Common side effects of duloxetine include:

  • nausea
  • dry mouth
  • constipation
  • tiredness

Alternative medications

Nortriptyline and imipramine

Nortriptyline and imipramine are two alternative medications that can be used if the medications above do not work or cause distressing side effects.

Both these medications are similar to amitriptyline, but they have some important chemical and biological differences. Therefore, they may be an effective alternative treatment if amitriptyline does not work or causes too many unpleasant side effects.

If you experience side effects while taking nortriptyline or imipramine, they are likely to be similar to the side effects associated with amitriptyline (see above).

Topical lidocaine

Topical lidocaine is a mild local anaesthetic that numbs the skin and surrounding nerves. It is available as a cream, ointment, gel or spray. It may be recommended to treat localised pain if you cannot take the oral medications (tablets or capsules) above due to medical or other reasons.

Possible side effects of topical lidocaine include:

  • redness
  • swelling
  • irritation
  • itchiness

These side effects are usually mild.

Tramadol

Tramadol is a powerful opiate-based painkiller that can be used to treat cases of neuropathic pain that do not respond to any other treatment.

Like all opiates, tramadol can be addictive if it is taken for a long time. Therefore, it will usually only be prescribed for a short period, such as while you are waiting to be referred to a specialist in treating neuropathic pain.

Common side effects of tramadol include:

  • nausea
  • dizziness
  • constipation
  • sweating
  • dry mouth
  • confusion
  • headache
  • vomiting 

Page last reviewed: 27/06/2012

Next review due: 27/06/2014

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Comments

The 6 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Vivid images said on 13 January 2014

@Suzydoll,hi Sue,I have pn caused by brain damage of the frontal lobe after an operation for decompression of the spine.I didn't come out of a coma for13months.I am sorry to say,but I don't think there is a cure for pn.I find Tramadol the best if the pain gets really bad,I've tried the others but they don't work for me.I hope you will find some relief sooner or later.Good luck.

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Spireman said on 11 August 2013

I am 65 years old. I have type 2 diabetes and B12 deficiency as my body cannot covert B12 and I have a three monthly injection to combat this.
I also suffer regularly from gout in my feet ankles, elbow and wrist. I am overweight at 5'10 and 14 stone.
I also like my beer and drink around 4 pints most evenings. I have had painful hands and feet for a number of years and always put this down to Uric acid and gout especially as my doctor has diagnosed this. However, having read the causes of peripheral neuropathy I am sure that this is my problem. Walking is painful,it feels like I am walking on gravel, my soles throb, even in bed and some of my toes are numb. I am already on a range of tables, Bisoprolol, Simverstatin, Allopurinol, Colchicine, and Naproxin so am wary about taking any others.

Is PN reversible or will it get steadily worse?

Do I have to stop drinking beer altogether?

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alancant said on 03 August 2013

I have PN....I also suffer diabetes.

I did not know I had a problem until I was told I had diabetes, after all it does not hurt and I feel fine. I have tried pills to stem the pain of PN but they dont work.
Now my train of thought is "if I found something to kill the pain of PN then I would not be aware or feel the effect of diabetes. I would be ignorant of the long term effect it causes and would do nothing about the problem"
So..... i feel the pain everyday....and every day I am reminded of the problem I have, and try everyday to do something about it. Eating less, try to loose weight and drink less !!! And guess what. It seems to be working,slowly..

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dalmatian12 said on 25 April 2013

Recently I had an episode which was very much like a stroke where I lost the use of all my left hand side, arm, leg and speech and my face drooped. It was concluded that it was caused by migraines and were functional symptoms. Doctors were less than explanatory about this and I am still in great pain in one arm 4 weeks later and have a little weakness
Having a close family member with stroke, if I suffer this again, is it going to be ignored, or indeed should I ignore all the symptoms that are indeed the same as a TIA or stroke or also Peripheral Neuroathy ? I also have a history of a splenic arterial aneurysm which took 21/2 years of agonising pain and a second opinion before a sympathetic surgeon removed my spleen and abdominal pain .
I feel that if something is not fully understood, it is far easier for doctors to dismiss patients as being paranoid.or maybe get referred to a psychiatrist if they have A Functional neurological Disorder which I think is ridiculous and insulting. However I am now I am now very confused with what I do if I have future severe attacks, and what to do with the remaining symptoms and I really think if doctors do not have a clear clinical picture, it gets labelled as Functional and Dissociative Neurological symptoms.

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michaelebriant said on 12 April 2013

I was diagnosed with PN about 10 years ago having had electrical current tests etc and complaining of pain in addition to the numb bandage like pins and needles in my legs. I was prescribed the 'pain killers' listed above and frankly found they were worse than the pain - ruined my quality of life and made me drowsy. I just stopped taking them and keep active and live with the painful bits. I am a bit overweight but keep working on that. I go sailings regularly and for the most part try not to bother about it!

Sure it is not pleasant but it is bearable and although it is all the way up my legs and both hands and arms I prefer to just get on with it rather than resort to what are very powerful drugs that do not even give you a buzz!

Maybe I will go and see another doctor and get re-assessed but I don't think there is a cure so what's the point in taking pain killers unless you really need them?

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suzydoll1964 said on 08 December 2012

hi am getting investigated for peripheral neuropathy and am a bit scard now reading all the things that it could lead to i have alot of tablets to take at the moment and yes am over weight tooo my knees are not working right so trying to do any kind of moving about or excisic it painfull how can i try and stop this from happyening to me iv had problems since 2002 and my body has just got worse as the years have went on my knees my back my neck my hands and allmost every joint i have has something wrong with it and its not just down to be being big because when all this started i wasnt as big as i am now but doctors keep telling me its your weight well if i could do anything i would i stopped smoking 8 years ago thank god and i can only swim but thats not enough iv tryed diet pills in the pass i watch what i eat am not stuffing my face with choc or chips or mcdonalds or greesy food but i still cant loss the weight because all i can do is swim and i cant even be normal like i used to be i hate being like this it gets me down but can anyone tell me what i can do please there is no one apart from my doctor but she cant do anything because i am in so much pain everywhere else in my body can anyone help please thanks regards susan

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Which painkiller?

The drugs you should take to treat pain depend on what type of pain you have

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