Combination therapies for Neuropathy

If you search via Google: The importance of drug development for neuropathy, unless you are a medical specialist, you may well think that you've landed on another planet when you read the results! The first five pages consist of articles which are so scientifically complex, that the ordinary, unqualified, neuropathy-sufferer doesn't stand a chance of understanding what sort of progress is being made! What does emerge as being indisputable is the depressing fact that there is very little real understanding of why and how, neuropathic pain works, let alone finding an effective treatment.

We already know that there are more than one hundred potential causes of neuropathy; how it can be affected by a variety of other ailments and that everyone reacts differently to both tests and progression. Yet how is that any different to cancer, or even HIV and yet, given the right amount of publicity and money, significant progress has been made in treating both of those complex diseases?

Treatment up to now has been mainly aimed at relieving the symptoms and the discomfort or pain, which in the case of autonomic neuropathy for instance, can be a jigsaw in itself. This suggests that science is nowhere near addressing the damage to the nervous system itself. Okay, if that's the case, just tell us that in layman's terms and we'll understand that treatment is limited and as long as we're cautious and wary about being screwed by unscrupulous salesmen and take doctor's advice about the dangers, it's okay to explore the many alternative therapies that spring up all the time.

Having said all that, it seems that science is now moving in the direction that HIV eventually also had to do to achieve success - by using combination treatments and therapies. It seems logical, even though we understand that they're often holding their scientific wet thumbs in the air to test the wind.

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Two very important points before we go any further:
1) Always check for yourself, whether any drugs you are prescribed clash with your HIV regime - doctors don't always have the time, or can forget. A good site for checking your meds is http://www.drugs.com/drug_interactions.php or you could use: http://www.hiv-druginteractions.org/

2) Watch out for side effects, especially with combinations (they can sometimes be worse than the problem itself) - always report back to your doctor.
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Before we go on to the combinations, the following link is a list of the most commonly prescribed drugs for neuropathy. It's very useful and will explain what is being prescribed, in terms you can understand. It might be an idea to add it to your favourites for future reference.
http://www.drugs.com/condition/peripheral-neuropathy.html

The most frequently used combinations at the moment are:
Tramadol and Gabapentin (Neurontin); Oxycodone and Gabapentin and morphine and Gabapentin which are combinations of an opioid with an anticonvulsant. Pregabalin (Lyrica) can also be used instead of Gabapentin but Pregabalin is still an anticonvulsant.
Nortryptiline (tricyclic antidepressant) can be used in combination with an opioid (Tramadol or Oxycodone) or even, in some cases be added to the mix to make a triple therapy with an opioid and an anticonvulsant. It is often the case that the dosage of either or both of the individual drugs may be reduced when they are used in combination.

It all sounds very complicated but basically, you will generally begin any treatment with one drug at a time (monotherapy) and if none of the available drugs work, your doctor may offer combinations of two, or maybe even three, normally monotherapy drugs, to form a combination therapy. Remember, these treatments are still not curing anything, they are just meant to make the symptoms less difficult to live with.
Quite a few large scale studies have already been done, with generally encouraging results and more are happening all over the world, especially in Asia, though it has to be said that most are aimed at diabetics with neuropathy and HIV patients must watch out for drug clashes which may affect their HIV therapy.

These are conclusions of one such study to be found on: http://www.medscape.com/viewarticle/723244_9

Combination Therapy

An adequate trial of a single medication followed by titration to alleviate pain should be the first step in managing (diabetic) neuropathy. Managing adverse effects should be a continuous process throughout treatment. Drug tapering or discontinuation may be required if the adverse effects are intolerable. If a single drug therapy is ineffective, utilizing combination therapy may be the next step. This has been shown in the recent article published by Gilron et al. The authors concluded that gabapentin in combination with nortriptyline was more efficacious than either drug alone for the treatment of neuropathic pain. This article recommends the use of combination therapy with gabapentin and nortriptyline for patients who show a partial response to either drug alone. While further studies are needed to evaluate the use of combination therapy for treatment of neuropathic pain, the use of combination therapy is more widely acceptable by clinicians.

Hopefully combination therapies will become more sophisticated and will eventually make living with neuropathy much easier. However, with regards to finding a 'cure', it looks like that will still take some considerable time. Patience is something neuropathy sufferers know all about.