Medication is usually the first option taken for nerve pain, and it’s an important topic. The first thing you need to know is that normal painkillers do not affect neuropathic pain. This includes anti-inflammatories, Paracetamol, Acetaminophen, Codeine, and so on; all these make very little difference to neuropathic pain.
Now, there are two main types of medication that are used worldwide to treat nerve pain. The big disclaimer here is that they work, but they don’t work well; this is a terribly important fact to be aware of. These medications also have side effects.
Pregabalin & Gabapentin for Nerve Pain
The first group are anti-epilepsy medications, which work on the nerve itself. The most commonly used are Tegretol, which is used for trigeminal neuralgia, and Pregabalin and Gabapentin.
If you look at the visual in the video above, the lining of this nerve–the Axon–has tiny little holes in the wall, all along it. Inside these holes is a pump, which pumps sodium against the concentration gradient. It pumps the sodium ions, which have a little charge, to create an electrical charge across the membrane.
These sodium pumps are incredibly important because they pump till they reach a threshold and then they fire–turning the nerve on. Nerves have an on/off switch. They don’t have a “half-on”; they’re either on or off. This is why the pain that you feel can go from nothing, to “Ah, God, that’s horrible!”
Anti-epileptic medications try and stabilize the membrane of the nerve by affecting the sodium pumps to make them less active.
“Number Needed to Treat” (and why this is important)
There’s an important number when you assess a medication: it’s called “number needed to treat” or NNT. This stands for how many people you need to treat before you get a 50% pain reduction.
The NNT of Gabapentin and Pregabalin is about six, so five people are going to have less than 50% pain reduction and one person is going to have more than 50% pain reduction–which is dismal, but it’s that’s fairly standard for nerve pain medications. So if you get 30% to 50% pain relief on any of these medications, you’re doing very well indeed.
Nortriptyline and Amitriptyline for Nerve Pain
The second group is the antidepressant medications, and there are two subgroups of these.
The first are the tricyclics–that’s amitriptyline, nortriptyline, and a few others. The second subgroup consists of Serotonin and noradrenaline. These are reuptake inhibitors. All of these medications work on the place when one nerve talks to another – the synapse. They’re actually working on the central sensitization components.
I want this to be very clear because when you have nerve damage, you try to control the nerve and make it less grumpy. Maybe you can fix it if you find the underlying cause, but if you don’t, then you’ve got a grumpy nerve that’s going to fire. When it fires and it comes to the spinal cord, it hypes up your pain system.
This is why NeuroMind techniques have a big role to play here. With neuropathic pain, there is almost always a pain system malfunction that occurs with it.
Some other common medications in the antidepressant category include:
Amitriptyline
Nortriptyline
Duloxetine (Cymbalta)
Savella (Milnacipran)
Venlafaxine
All of these medications are changing the neurotransmitters. These transmitters fire when one nerve talks to another, and these medications change how they function. In so doing, they normalize or improve your pain system function. Again though, their results are no better than the medications we talked about earlier.
Interestingly, Amitriptyline has the best NNT. The NNT number is three. This means if you treat three people, one of them will get at least a 50% pain relief. The one small (very large) problem is that at a dosage of 150 milligrams of Amitriptyline, you could put a medium-sized elephant to sleep.
All these medications come with their own host of problems. You often have to mix and match them to get a good result. You try one dose and build that dose up until you reach a certain point of optimal pain relief. Then you add in another one and make sure they don’t fight with each other. You then increase that dose until you find that you’re feeling a bit better (but not to the point where you feel worse.)
Opioids for Nerve Pain
The other big group of medication for pain is opioids. These are really the bad guys, and do not work well for neuropathic pain.
The one opioid that seems to work sometimes for neuropathic pain is Methadone. This is the cheapest, the most complicated to use, and probably the most dangerous of all the opioids. With Methadone, if you get the dose right, you have the NNT at about six or seven–not very exciting. But again, when you add several medications together, you may see some added benefit.
The last of the opioids are cannabinoids, such as marijuana. Just like you have the opioids for the receptors in your body, you’ve have cannabinoid receptors all the way through your brain and your spinal cord.
Again, the results are not exciting in terms of neuropathic pain. All are slightly effective but have side effects and problems. So there is no simple solution to this complex question. If you find one or more medication mixtures and you get the dose just right, you may find you get 30% to 50% pain relief or even better. That is wonderful – though you also need to take into account any side effects.
Take with Caution
All of the medications mentioned effect nerves, and you have the highest concentration of in your brain. So the common side effects of neuropathic medications are cognitive. This means you can’t think clearly, you feel sleepy or dizzy, you may forget things. On top of this, each medication has its own specific side effects.
If you have neuropathic pain you need to enter into this minefield carefully, not being pushed into anything. Start a new medication slowly, on a very low dose. If you’ve been in pain for a long time, everything in your system is sensitized. So go slowly. If a particular medication doesn’t work, throw it away and start again.
NeuroMind Techniques for Nerve Pain
We talk a lot on this site about mind-body or NeuroMind techniques. They absolutely have a place in neuropathic pain because a huge part of neuropathic pain is your pain system hyping up pain messages.
Therefore these techniques are incredibly important (and have no side effects.) Neuropathic pain can be hard to treat because it comes on so suddenly. But when you get your technique right, what people have found is that the pain will occur less often, and last for shorter time periods. Mastering a NeuroMind technique brings control over the pain.
So it is absolutely is worthwhile practicing NeuroMind techniques as part of the long-term plan to recover from neuropathic pain.
Here’s where to find out more on rewiring your pain system for pain relief.
You left out acetyl L carnitine (alcar) and alpha lipoic acid (ala). I tried the standard prescribed drugs – which were useless for neuropathic pain. The combination of ALA and ALCAR are remarkably effective – 98% reduction in pain – with (so far), sustained effect for the last 5 years. This omission (despite the scientific literature’s reported results that are lukewarm) is a disservice to the public. Scientific literature, while essential to science – is not holy writ – 2/3’s of all scientific article’s results are not replicable – look it up. It’s a well known fact in scientific circles – much less well known by the public. My comments are for the mixed version of ALA – not R-ALA (which I have not used).
Thanks for your comment Michael. It’s great you found something that worked for you. However, (as you have stated in regards to scientific studies) there is no one-size-fits-all solution.
Everyone is different, and people need to explore this topic individually to find out what works for them.
