When over-the-counter pain medications do not relieve the pain associated with peripheral neuropathy, other types of medications and therapies are available, including prescription nonsteroidal anti-inflammatory drugs, narcotics, antidepressants, and topical medications.
COX-2 Inhibitors (includes Celebrex®)
COX-2 inhibitors are a relatively new type of nonsteroidal anti-inflammatory drug (NSAID) that reduces pain and inflammation by blocking a specific enzyme (COX-2) in the body. COX-2 inhibitors are less likely to cause gastrointestinal problems or bleeding than traditional NSAIDs (e.g., aspirin or ibuprofen) and may be a safer alternative for certain patients. However, because COX-2 inhibitors do not inhibit blood clotting (thin the blood), as do other NSAIDs — especially aspirin — they should not replace aspirin as a heart treatment.
COX-2 inhibitors include:
- Celecoxib (Celebrex®)
- Valdecoxib (Bextra®)
Narcotics, also known as opioids, are used to relieve severe and chronic pain. They are prescribed when other pain medications and therapies do not seem to work. These drugs are often used in combination with other medications such as antidepressants, anticonvulsants, and non-narcotic pain relievers. Opioids are the strongest pain medicines available and may become addictive if used on a long-term basis.
There are different types of opioids, which include:
- Hydromorphone (Dilaudid®)
- Meperidine (Demerol®)
- Methadone (Dolophine®)
- Morphine (MS Contin® and others)
- Oxycodone (OxyContin®)
Tramadol is a pain medication prescribed to treat moderate-to-severe acute pain. Its effectiveness in treating chronic pain is still being studied. It has properties similar to both opioids (narcotics) and antidepressants. Tramadol reduces pain by interfering with pain signals to the brain (like an opioid) and by affecting neurotransmitters (like an antidepressant).
Anti-depressants as pain relievers
Sometimes, drugs developed and used to control other conditions are effective pain relievers. In addition to relieving depression, many antidepressant drugs can relieve chronic pain. These drugs also may improve sleep quality, which may in turn help reduce pain. In some cases, antidepressants work by treating accompanying depression that makes chronic pain more difficult to handle.
Selective serotonin reuptake inhibitors (SSRIs) are a new type of antidepressant drug that is used to treat pain caused by neuropathy. SSRIs restore the chemical balance in the brain’s nerve cells. Common SSRIs used to treat neuropathy pain include:
- Paroxetine hydrochloride (Paxil®)
- Fluoxetine (Prozac®)
- Sertraline (Zoloft®)
- Citaprolam (Celexa®)
- Fluvoxamine (Luvox®)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a new type of antidepressant medication that may alleviate pain caused by neuropathy. These drugs affect the nerve cells in the brain and inhibit the production and release of specific neurotransmitters (serotonin and norepinephrine).
Examples of serotonin and norepinephrine reuptake inhibitors include:
- Duloxetine (Cymbalta®)
- Venlafaxine (Effexor®, Effexor XR®)
Norepinephrine reuptake inhibitors (NRIs) are a type of antidepressant medication that may reduce neuropathic pain. These drugs affect the nerve cells in the brain and inhibit the reuse of specific neurotransmitters (dopamine, serotonin, and norepinephrine), which may alleviate depression by achieving a chemical balance in the brain.
Examples of norepinephrine reuptake inhibitors are:
- Bubropion (Wellbutrin®, Wellbutrin SR®)
- Ludiomil (Maprotiline®)
Serotonin receptor modulators are antidepressant medications that may relieve neuropathic pain. These drugs work to achieve chemical balance within the brain by increasing the levels of serotonin and norepinephrine available to transmit messages to other nerves.
Serotonin receptor modulators include:
- Nefazodone (Dutonin®)
- Trazodone (Desyrel®)
Mexiletine (Mexitil®), an orally taken form of lidocaine, was originally approved to treat irregular heartbeats, but sometimes is effective in the relief of chronic nerve pain. Mexiletine reduces pain by adhering to peripheral nerves and reducing pain signals carried from the peripheral nerves to the central nervous system and brain. Over time, as mexiletine bonds to the peripheral nerves, the feeling of pain is diminished. Mexiletine is being used experimentally to treat pain associated with different kinds of peripheral neuropathy.
Alpha-2 Andrenergic Agonists
There are two alpha-2-adrenergic agonists that have some evidence as pain relievers: tizanidine (Zanaflex®) and clonidine (Catapres®). There are some studies showing that tizanidine can be effective for tension-type headache, back pain, neuropathic pain and myofascial pains. Clonidine has been used to treat neuropathic pain that is not responding to other treatment or therapy.