NHS Choices - Your Health, Your Choices
NB: St John’s wort
Many of the medications discussed on this page can react unpredictably if they are taken in combination with the herbal supplement St John’s wort.
St John’s wort has been widely promoted as a herbal treatment for depression and is available to buy in most health stores without the need for a prescription.
It is strongly recommended that you do not take St John’s wort if you are taking one of the medications described on this page (with the exception of topical lidocaine).
http://www.nhs.uk/Conditions/Peripheral-neuropathy/Pages/Treatment.aspx
Last reviewed: 27/06/2012: Next review due: 27/06/2014
Treatment for peripheral neuropathy will address the underlying cause for the condition, and, if necessary, the symptom of nerve pain.
For example, in cases of diabetic polyneuropathy you may be advised to make lifestyle changes to help control your diabetes, and prevent further nerve damage. These may include:
giving up smoking
cutting down on your alcohol consumption, or ideally not drinking alcohol at all
maintaining a healthy weight, if you are overweight or obese
taking plenty of exercise
Neuropathic pain
As well as addressing the underlying causes of peripheral neuropathy, you may also require additional medication to treat the symptoms of nerve pain. The medical term for nerve pain is neuropathic pain.
Unlike most other types of pain, neuropathic pain does not usually respond well to treatment with widely used painkillers, such as paracetamol and ibuprofen. Therefore, alternative medications are usually required.
As many of these medications can cause a wide range of side effects, it may take some time to identify a medication that is right for you.
Therefore, you may need to try a number of the medications described below before you find one that suits you. In some cases, you may need to take a combination of different medications.
Initial treatments
Medications called amitriptyline and pregabalin are the initial treatments for people with neuropathic pain that is not associated with diabetes.
If you have diabetes, you should be offered a medication called duloxetine as your first treatment. If you are unable to take duloxetine for medical reasons (for example, because you have chronic kidney disease) amitriptyline may be used as an alternative.
Amitriptyline
Amitriptyline was originally designed to treat depression, but it has subsequently proved to be effective in treating some cases of neuropathic pain.
If you are prescribed amitriptyline, the lowest possible dose will usually be recommended. If the medication is not effective, your dosage can be gradually increased. This approach will help lower your risk of getting side effects.
Common side effects of amitriptyline include:
dry mouth
constipation
sweating
problems passing urine
slight blurring of vision
drowsiness
If you experience drowsiness or blurred vision, do not drive or operate machinery.
The side effects should ease after 7 to 10 days as your body gets used to the medication. However, if your side effects continue or if they become troublesome, tell your GP because it may be possible to change to a different medication that suits you better.
Some people have reported having thoughts of hurting or killing themselves while taking amitriptyline. If this happens to you, see your GP or go to your nearest hospital immediately.
It may be helpful to tell a close friend or relative that you are taking amitriptyline and ask them to keep an eye out for any changes in your behaviour. Do not drink alcohol when you are taking amitriptyline because the combined effects can make you feel very drowsy.
Pregabalin
Pregabalin can be used as an initial treatment for neuropathic pain if you are unable or unwilling to take amitriptyline. As with amitriptyline, you will be prescribed the lowest possible dose necessary to control your symptoms. If required, the dose can be adjusted.
The two most common side effects of pregabalin are:
dizziness
tiredness
Do not drive if you experience these side effects.
Duloxetine
Duloxetine was originally designed to treat severe depression, but it has proved to be effective in treating neuropathic pain associated with diabetic polyneuropathy.
As with amitriptyline, there have been reports of people suddenly having thoughts of hurting or killing themselves after taking duloxetine. See your GP or go to your nearest hospital immediately if you experience such thoughts.
Common side effects of duloxetine include:
nausea
dry mouth
constipation
tiredness
Alternative medications
Nortriptyline and imipramine
Nortriptyline and imipramine are two alternative medications that can be used if the medications above do not work or cause distressing side effects.
Both these medications are similar to amitriptyline, but they have some important chemical and biological differences. Therefore, they may be an effective alternative treatment if amitriptyline does not work or causes too many unpleasant side effects.
If you experience side effects while taking nortriptyline or imipramine, they are likely to be similar to the side effects associated with amitriptyline (see above).
Topical lidocaine
Topical lidocaine is a mild local anaesthetic that numbs the skin and surrounding nerves. It is available as a cream, ointment, gel or spray. It may be recommended to treat localised pain if you cannot take the oral medications (tablets or capsules) above due to medical or other reasons.
Possible side effects of topical lidocaine include:
redness
swelling
irritation
itchiness
These side effects are usually mild.
Tramadol
Tramadol is a powerful opiate-based painkiller that can be used to treat cases of neuropathic pain that do not respond to any other treatment.
Like all opiates, tramadol can be addictive if it is taken for a long time. Therefore, it will usually only be prescribed for a short period, such as while you are waiting to be referred to a specialist in treating neuropathic pain.
Common side effects of tramadol include:
nausea
dizziness
constipation
sweating
dry mouth
confusion
headache
vomiting
Last reviewed: 27/06/2012
Next review due: 27/06/2014
For example, in cases of diabetic polyneuropathy you may be advised to make lifestyle changes to help control your diabetes, and prevent further nerve damage. These may include:
giving up smoking
cutting down on your alcohol consumption, or ideally not drinking alcohol at all
maintaining a healthy weight, if you are overweight or obese
taking plenty of exercise
Neuropathic pain
As well as addressing the underlying causes of peripheral neuropathy, you may also require additional medication to treat the symptoms of nerve pain. The medical term for nerve pain is neuropathic pain.
Unlike most other types of pain, neuropathic pain does not usually respond well to treatment with widely used painkillers, such as paracetamol and ibuprofen. Therefore, alternative medications are usually required.
As many of these medications can cause a wide range of side effects, it may take some time to identify a medication that is right for you.
Therefore, you may need to try a number of the medications described below before you find one that suits you. In some cases, you may need to take a combination of different medications.
Initial treatments
Medications called amitriptyline and pregabalin are the initial treatments for people with neuropathic pain that is not associated with diabetes.
If you have diabetes, you should be offered a medication called duloxetine as your first treatment. If you are unable to take duloxetine for medical reasons (for example, because you have chronic kidney disease) amitriptyline may be used as an alternative.
Amitriptyline
Amitriptyline was originally designed to treat depression, but it has subsequently proved to be effective in treating some cases of neuropathic pain.
If you are prescribed amitriptyline, the lowest possible dose will usually be recommended. If the medication is not effective, your dosage can be gradually increased. This approach will help lower your risk of getting side effects.
Common side effects of amitriptyline include:
dry mouth
constipation
sweating
problems passing urine
slight blurring of vision
drowsiness
If you experience drowsiness or blurred vision, do not drive or operate machinery.
The side effects should ease after 7 to 10 days as your body gets used to the medication. However, if your side effects continue or if they become troublesome, tell your GP because it may be possible to change to a different medication that suits you better.
Some people have reported having thoughts of hurting or killing themselves while taking amitriptyline. If this happens to you, see your GP or go to your nearest hospital immediately.
It may be helpful to tell a close friend or relative that you are taking amitriptyline and ask them to keep an eye out for any changes in your behaviour. Do not drink alcohol when you are taking amitriptyline because the combined effects can make you feel very drowsy.
Pregabalin
Pregabalin can be used as an initial treatment for neuropathic pain if you are unable or unwilling to take amitriptyline. As with amitriptyline, you will be prescribed the lowest possible dose necessary to control your symptoms. If required, the dose can be adjusted.
The two most common side effects of pregabalin are:
dizziness
tiredness
Do not drive if you experience these side effects.
Duloxetine
Duloxetine was originally designed to treat severe depression, but it has proved to be effective in treating neuropathic pain associated with diabetic polyneuropathy.
As with amitriptyline, there have been reports of people suddenly having thoughts of hurting or killing themselves after taking duloxetine. See your GP or go to your nearest hospital immediately if you experience such thoughts.
Common side effects of duloxetine include:
nausea
dry mouth
constipation
tiredness
Alternative medications
Nortriptyline and imipramine
Nortriptyline and imipramine are two alternative medications that can be used if the medications above do not work or cause distressing side effects.
Both these medications are similar to amitriptyline, but they have some important chemical and biological differences. Therefore, they may be an effective alternative treatment if amitriptyline does not work or causes too many unpleasant side effects.
If you experience side effects while taking nortriptyline or imipramine, they are likely to be similar to the side effects associated with amitriptyline (see above).
Topical lidocaine
Topical lidocaine is a mild local anaesthetic that numbs the skin and surrounding nerves. It is available as a cream, ointment, gel or spray. It may be recommended to treat localised pain if you cannot take the oral medications (tablets or capsules) above due to medical or other reasons.
Possible side effects of topical lidocaine include:
redness
swelling
irritation
itchiness
These side effects are usually mild.
Tramadol
Tramadol is a powerful opiate-based painkiller that can be used to treat cases of neuropathic pain that do not respond to any other treatment.
Like all opiates, tramadol can be addictive if it is taken for a long time. Therefore, it will usually only be prescribed for a short period, such as while you are waiting to be referred to a specialist in treating neuropathic pain.
Common side effects of tramadol include:
nausea
dizziness
constipation
sweating
dry mouth
confusion
headache
vomiting
Last reviewed: 27/06/2012
Next review due: 27/06/2014
NB: St John’s wort
Many of the medications discussed on this page can react unpredictably if they are taken in combination with the herbal supplement St John’s wort.
St John’s wort has been widely promoted as a herbal treatment for depression and is available to buy in most health stores without the need for a prescription.
It is strongly recommended that you do not take St John’s wort if you are taking one of the medications described on this page (with the exception of topical lidocaine).
http://www.nhs.uk/Conditions/Peripheral-neuropathy/Pages/Treatment.aspx
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