Understanding and Managing Neuropathic Pain

Neuropathic pain not only causes physical discomfort but is also a persistent source of annoyance to the sufferer! Unlike typical pain, it originates from nerve damage, leading to sensations like burning, tingling, or sharp distress. Managing it can be challenging, often affecting daily activities and overall well-being.

Neuropathic pain usually comes on slowly. It is often characterized by burning, numbing, or tingling sensations, sometimes accompanied by a "stabbing" or throbbing pain. The discomfort is strange and often persistent; sensation to touch and temperature may be altered. Neuropathy typically occurs in the extremities - the feet, legs, hands, and arms. If it becomes serious, there may be a loss of bowel or bladder control and inordinate weakness.

The underlying cause of neuropathy is nerve damage or compression: Nutrients cannot get to the nerve so it becomes damaged. It can be caused by injury, underlying disease (like poorly controlled diabetes which is common - high blood sugar levels destroy nerve fibers; Parkinson's, MS, or tumors), by certain medications (chemotherapeutic drugs are common, some antibiotics, hydralazine, colchicine and others), cancer radiation treatments, chemicals (i.e. lead exposure), alcoholism, malnutrition, Vitamin B12 deficiency or vitamin B6 excess, kidney disease, hypothyroidism, illness like Lyme disease or long covid, and others. Emotional stress can make it worse.

In some cases, neuropathy can improve - even go away if the underlying cause can be corrected. For example, neuropathy from repetitive motion injuries may improve once the motion ceases and the nerve irritation is alleviated. In other cases, however, there may be no recovery because of permanent damage (like radiation therapy and sometimes chemotherapy).

General Approaches to Neuropathy

• Gentle exercise of the area, easy walking, swimming/hydrotherapy

• Physical therapy 

• Weight loss if overweight (high BMI)

• Smoking cessation

• Supportive devices/braces

• Cognitive Behavioral Therapy (CBT)

• Relaxation techniques like meditation, guided imagery

• Yoga

• Tai Chi

​​Over-the-Counter Approaches to Neuropathy

NSAIDS:  These include Ibuprofen (Motrin, Advil), Naproxen (Aleve), and Aspirin and are quite effective in decreasing pain in many cases. They are always good medications to start with if you are having pain - especially pain from inflammation (almost all pain has some element of inflammation). BUT on a long-term basis, these medicines can cause gastric ulcers and bleeding as well as kidney and blood pressure issues, so beware - alternate your pain medications (NSAIDS) if possible - ibuprofen to Tylenol or a prescription medicine. Speak to your PCP about this and also, consider taking a stomach acid-reducing medicine (common: omeprazole/Prilosec or famotidine/Pepcid and others) while taking NSAIDs. Remember: Aspirin thins your blood and can make you bleed more easily.

Acetaminophen (common: Tylenol), on the other hand, is not an anti-inflammatory but a pain reliever instead. This is also a good medication but, used long term, can cause liver problems. Again, consider alternating this with ibuprofen every few weeks or speak to your PCP about getting another prescription pain medication.

There is now a combination product that has both ibuprofen and acetaminophen in it (Advil Dual Action) which makes a lot of sense seeing that they both work in different ways.

Corticosteroids have lots of potential side effects from ulcers to diabetes, to hypertension to insomnia and sometimes downright psychosis but they are great anti-inflammatories. Sometimes healthcare providers prescribe low dose to use over long term but because of the potential side effects, it is good to look at some of the alternatives.

Topical Pain Relievers

• Menthyl salicylate (an anti-inflammatory related to Aspirin)

• Voltaren/diclofenac

• Lidocaine patches (common: Salonpas, Icy Hot)

Considered natural and herbal approaches​

• Peppermint lotions and creams

• CBD - Topical

• Vitamin B12, vitamin E and magnesium supplementation

• Capsicum (pepper cream) - topical

• Curcumin/Turmeric

• Holy Basil (Tulsi)

• Ginger

• Boswellia

  
  

Neuropathic Pain

Prescriptive Treatment

• Duloxetine/Cymbalta (SNRI/serotonin norepinephrine reuptake inhibitor) and amitriptyline (tricyclic antidepressant) - decrease pain transmission

• Lidocaine injections

• Cox-2 inhibitors (common: celecoxib (Celebrex), meloxicam (Mobic), which are anti-inflammatories. These are likely to cause fewer stomach problems than ibuprofen and other NSAIDs.

• Opioids: Opioids (short-term) - These are painkillers such as oxycodone or hydrocodone, (combo opioids with Tylenol: Lortab, Percocet and Vicodin) and Tramadol (i.e. Ultram). Because these are highly addictive, they are not the drug of choice for long-term pain

  They are controlled substances generally used for severe pain.

• Naltrexone and chronic pain

• Antiseizure medications: Gabapentin, Pregabalin (Lyrica) - for nerve pain

• Antidepressants (just because you take a medicine labeled "antidepressant doesn't mean you are depressed! These are frequently used for some pain syndromes and help alter neurotransmission signals in pain).

• Muscle relaxers are sometimes used for related spasms (common: cyclobenzaprine, methocarbamol) 

• High dose ibuprofen (800 mg)

• Biologics (newer addition to the mix)

For more information about peripheral neuropathy, the Foundation for Peripheral Neuropathy

​has a lot of helpful information.

​If you develop sudden weakness, numbness and tingling, or loss of bladder or bowel control, see a healthcare provider right away (ER)!! 

Otherwise, f you have any questions about your pain, see a healthcare provider. Treat early.