Peripheral neuropathy - Treatment 

Treating peripheral neuropathy 

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Media last reviewed: 20/02/2013

Next review due: 20/02/2015

Alternative and complementary treatments

As peripheral neuropathy can be a very painful and troublesome condition that may only partly be relieved by medication, some people may be tempted to try other treatments, such as:

  • acupuncture
  • herbal medicine
  • benfotiamine (a form of vitamin B1) supplements
  • alpha-lipoic acid (an antioxidant) supplements

However, while some people may find these helpful, the evidence for them is not always clear. It is advisable to speak to your doctor before trying these treatments in case they could interfere with your ongoing treatment.

Treatment for peripheral neuropathy may include treating any underlying cause and any symptoms you are experiencing.

How successful treatment will be depends on the underlying cause. For example, in peripheral neuropathy caused by diabetes, ensuring your diabetes is well controlled may help improve neuropathy or at least stop it getting worse.

Treating the underlying cause

There are many different possible causes of peripheral neuropathy, some of which can be treated in different ways. For example:

  • diabetes can sometimes be controlled by making healthy lifestyle changes, such as stopping smoking, cutting down on your alcohol consumption, maintaining a healthy weight and exercising regularly
  • vitamin B12 deficiency can be treated with B12 injections or tablets
  • peripheral neuropathy caused by a medication you are taking may improve if the medication is stopped

Some less common types of peripheral neuropathy may be treated with medication such as corticosteroids (powerful anti-inflammatory medication), immunosuppressants (medications that reduce the activity of the immune system), or injections of immunoglobulin (a mixture of blood proteins called antibodies made by the immune system).

However, the underlying cause may not always be untreatable.

Relieving nerve pain

You may also require medication to treat any nerve pain you are experiencing. The medical term for nerve pain is neuropathic pain.

Unlike most other types of pain, neuropathic pain does not usually get better with common painkillers, such as paracetamol and ibuprofen. Alternative medications are therefore usually required.

These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect. The ideal dose for each person is unpredictable, so needs trial and error. Higher doses are more likely to help your pain, but are also more likely to cause side effects.

The most common side effects are tiredness, dizziness or feeling "drunk". If you get these, it may be necessary to reduce your dose. Do not drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.

The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GP as it may be possible to change to a different medication that suits you better. Many people find the first medication they try does not suit them, so they need to try others.

Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If you are given an "antidepressant", this may treat pain even if you are not depressed and does not mean your doctor suspects you are depressed.

The main medications recommended for neuropathic pain include:

  • amitriptyline – this is also used for treatment of headaches and depression
  • duloxetine – this is also used for treatment of bladder problems and depression
  • pregabalin and gabapentin – these are also used to treat epilepsy, headaches or anxiety

There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below.

Capsaicin cream

If your pain is confined to a particular area of your body and you can't, or prefer not to, take the medications above, you may benefit from using capsaicin cream.

Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain.

A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day.

Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment.

Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.

Lidocaine plaster

This is a large sticking plaster that contains a local anaesthetic. It is useful when pain affects only a small area of skin. It is stuck over the area of painful skin and the local anaesthetic is absorbed into the skin that is covered.

Tramadol

Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that does not respond to other treatments your GP can prescribe.

Like all opioids, tramadol can be addictive if it is taken for a long time. It will therefore usually only be prescribed for a short time. If your pain fluctuates in severity, tramadol can be useful to take at times when your pain is worse.

Common side effects of tramadol include:

  • feeling sick or vomiting
  • dizziness
  • constipation

Treating other symptoms

In addition to treating pain, you may also require treatment to help you manage other symptoms you are experiencing as a result of peripheral neuropathy.

For example, if you have muscle weakness, you may need to have physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.

Other problems associated with peripheral neuropathy, such as erectile dysfunction, constipation, or the slow movement of food through your stomach (gastroparesis), may be treatable with medication.

In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder.

Page last reviewed: 02/07/2014

Next review due: 02/07/2016

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Comments

The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

skinda1951 said on 29 July 2014

Been diagnosed with ph about 18 months ago after mri scan found slight swelling between discs causing a lot of pain , they treated with gabapentin and tramadol and left me to get on with it.
pain got worse sent to pain clinic at hospital waste of time think I run over my ten minute slot wanted me out, upped my gabapentin, I seem to have stabilized been virtually pain free,
last week doctors stopped my tramadol because given a controlled drug classification and they are panicking they may get told off, they changed medication to ibrobufen 400mg 3 times a day and paracetamel, I am now climbing the wall not through addiction but with pain, it would seem quality of life doesn't come into the equation any more

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steve212 said on 22 June 2014

Somebody told me there is vitamin called benfotianmine which has been on prescription in Germany for Decades for this condition. Maybe you could update your page with this information.

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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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