Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
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Many terms are used to describe neuropathic pain, such as:
Neuropathic pain can occur all the time or come in spurts. Likewise, neuropathic pain can range in intensity from mild and nagging to severe and disabling.
Neuropathic pain tends to be worse at night, which may disrupt your sleep.It also tends to flare at rest, which may affect relaxation or mealtime. Overall, the impact neuropathic pain has on one’s quality of life can lead to psychological problems, such as depression and anxiety.
Neuropathic pain is also common in diseases that attack sensory nerves, such as diabetes,and in conditions where certain nerves are inflamed or compressed, such ascarpal tunnel syndromeorsciatica. Nerve pain may also result from trauma, like with spinal cord injury, where nerves are damaged or severed.
Phantom limb painis another neuropathic pain disorder in which pain feels as if it is coming from a limb that was amputated.
Unfortunately, some types of neuropathic pain have an unknown origin or a cause that is not completely understood.Reflex sympathetic dystrophy(CRPS) is an example.Though the cause may not be fully known, the pain is very real.
In this instance, the diagnosis may require more testing, including blood tests, nerve tests likeelectromyography (EMG), or imaging tests, likemagnetic resonance imaging (MRI)of the brain or spinal cord.
Treatment of neuropathic pain usually involves addressing the underlying problem. For example, if a person has neuropathic pain from diabetes, optimizing blood glucose (sugar) control is an essential next step.Bear in mind, though, enhanced glucose control cannot generally reverse the neuropathy, although it can prevent it from getting worse and ease current symptoms.
As another example, if a medication is causing debilitating nerve pain, removal or a decrease in the dose of the offending drug may be all that is needed.
First-Line Medications
Besides treating the underlying problem, medication is often needed to manage neuropathic pain.
For the vast majority of patients, treatment of neuropathic pain involves taking one of the following:
The antidepressants and anti-seizure medications prescribed for neuropathic pain all come with a black-box warning (the U.S. Food and Drug Administration’s most serious warning) about their ability to cause suicidal thoughts and behaviors. If you or someone you know is given one of these drugs, make sure you know the signs andget help right awayif you see them.
All of the drugs may cause unpleasant side effects.
The most common side effects of Cymbalta include:
Elavil carries a risk for potentially fatal heart toxicity, as well as other bothersome side effects, including:
Neurontin may cause:
Lyrica side effects include:
In addition, you have to wean gradually off of these medications if you want to stop taking them. Withdrawal can be unpleasant and potentially dangerous in some cases.
Second-Line Medications
OpioidslikeVicodin (hydrocodone/acetaminophen) and Percocet (oxycodone/acetaminophen)are not as effective for treating neuropathic pain and, thus, are considered second-line treatments.
In addition to their questionable benefit, opioids are associated with several side effects that may severely affect your quality of life.
They include:
In addition to these side effects, there is a nationwide concern about opioid addiction and abuse, which must be considered.
Unique Therapies
There are some types of neuropathic pain that may require a unique treatment plan.
For instance, if your neuropathic pain is localized (confined to a small area), as is often the case in postherpetic neuralgia, atopical (on theskin) therapy, like a lidocaine patch may be used.
In other instances,surgerymay be necessary—for example, to release a compressed nerve, as in carpal tunnel syndrome.In the case of a herniated disc, in which an inflamed spinal nerve is a culprit behind the pain, an epidural steroid injection into the spine is sometimes performed.
Complementary Therapies
A variety of complementary therapies can help relieve neuropathic pain. These therapies are commonly used in combination with medications and include:
A Word From Verywell
Neuropathic pain is often chronic and can be challenging to treat. The good news is that there are a lot of treatment options, and often it’s the combination of therapies that does the trick. With that, remain persistent in your efforts to soothe your pain—but also aware that it’s often a trial and error process.
25 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic Health Library.Neuropathic pain.International Neuromodulation Society.Neuropathy, neuropathic pain, and painful peripheral neuropathy: many kinds, causes, and treatments.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M.Peripheral neuropathy and new treatments for multiple myeloma: Background and practical recommendations.Haematologica. 2010;95(2):311–319. doi:10.3324/haematol.2009.012674Fallon MT.Neuropathic pain in cancer.Br J Anaesth. 2013;111(1):105–111. doi:10.1093/bja/aet208Campbell JN, Meyer RA.Mechanisms of neuropathic pain.Neuron. 2006;52(1):77–92. doi:10.1016/j.neuron.2006.09.021Trevelyan EG, Turner WA, Robinson N.Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: A qualitative study.Br J Pain. 2016;10(2):70–77. doi:10.1177/2049463715590884National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.Merck Manual: Consumer Version.Neuropathic pain.Eli Lilly and Company.Highlights of prescribing information.Hocaoğlu N, Murat N, Mıcılı SC, Aydın B, Ergür BU, Kalkan Ş.Correlation between amitriptyline-induced cardiotoxic effects and cardiac S100b protein in isolated rat hearts.Balkan Med J. 2016;33(6):681–687. doi:10.5152/balkanmedj.2016.150435U.S. National Library of Medicine, StatPearls.Amitriptyline.Pfizer.Neurontin (gabapentin).Pfizer Parke-Davis.Lyrica-pregabalin capsule; Lyrica-pregabalin solution. Highlights of prescribing information.Vernachio K, Lovett AW, Williams J.A review of withdraw strategies for discontinuing antiepileptic therapy in epilepsy and pain management.Pharm Pharmacol Int J. 2015;3(1):232-235. doi:10.15406/ppij.2015.03.00045Harvard Medical School, Harvard Health Publishing.Going off antidepressants.Centers for Disease Control and Prevention.Preventing opioid overdose.American Society of Anesthesiologists.What are opioids.The University of Iowa, GeriatricPain.org.Side effects of opioid medications and general approaches to management.Ibrahim AM, Obaidi Z, Ruan G, Adaramola D, Onguti S.Nalbuphine for opioid-induced urine retention.Ann Intern Med. 2018;169(12):894–895. doi:10.7326/L18-0387Dhingra L, Ahmed E, Shin J, Scharaga E, Magun M.Cognitive effects and sedation.Pain Med. 2015;16 Suppl 1:S37–S43. doi:10.1111/pme.12912Merck Manual: Professional Version.Neuropathic pain.The University of California, UCSF Health.Trigeminal neuralgia.American Cancer Society.Peripheral neuropathy.The Foundation for Peripheral Neuropathy.Massage for neuropathy.Additional ReadingFornasari D.Pharmacotherapy for neuropathic pain: A review.Pain Ther.2017;6(Suppl 1):25-33. doi:10.1007/s40122-017-0091-4Gilron I, Baron R, Jensen T.Neuropathic pain: Principles of diagnosis and treatment.Mayo Clin Proc. 2015;90(4):532-45. doi:10.1016/j.mayocp.2015.01.018McNicol ED, Midbari A, Eisenberg E.Opioids for neuropathic pain.Cochrane Database Syst Rev.2013 Aug 29;(8):CD006146. doi:10.1002/14651858.CD006146.pub2
25 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cleveland Clinic Health Library.Neuropathic pain.International Neuromodulation Society.Neuropathy, neuropathic pain, and painful peripheral neuropathy: many kinds, causes, and treatments.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M.Peripheral neuropathy and new treatments for multiple myeloma: Background and practical recommendations.Haematologica. 2010;95(2):311–319. doi:10.3324/haematol.2009.012674Fallon MT.Neuropathic pain in cancer.Br J Anaesth. 2013;111(1):105–111. doi:10.1093/bja/aet208Campbell JN, Meyer RA.Mechanisms of neuropathic pain.Neuron. 2006;52(1):77–92. doi:10.1016/j.neuron.2006.09.021Trevelyan EG, Turner WA, Robinson N.Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: A qualitative study.Br J Pain. 2016;10(2):70–77. doi:10.1177/2049463715590884National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.Merck Manual: Consumer Version.Neuropathic pain.Eli Lilly and Company.Highlights of prescribing information.Hocaoğlu N, Murat N, Mıcılı SC, Aydın B, Ergür BU, Kalkan Ş.Correlation between amitriptyline-induced cardiotoxic effects and cardiac S100b protein in isolated rat hearts.Balkan Med J. 2016;33(6):681–687. doi:10.5152/balkanmedj.2016.150435U.S. National Library of Medicine, StatPearls.Amitriptyline.Pfizer.Neurontin (gabapentin).Pfizer Parke-Davis.Lyrica-pregabalin capsule; Lyrica-pregabalin solution. Highlights of prescribing information.Vernachio K, Lovett AW, Williams J.A review of withdraw strategies for discontinuing antiepileptic therapy in epilepsy and pain management.Pharm Pharmacol Int J. 2015;3(1):232-235. doi:10.15406/ppij.2015.03.00045Harvard Medical School, Harvard Health Publishing.Going off antidepressants.Centers for Disease Control and Prevention.Preventing opioid overdose.American Society of Anesthesiologists.What are opioids.The University of Iowa, GeriatricPain.org.Side effects of opioid medications and general approaches to management.Ibrahim AM, Obaidi Z, Ruan G, Adaramola D, Onguti S.Nalbuphine for opioid-induced urine retention.Ann Intern Med. 2018;169(12):894–895. doi:10.7326/L18-0387Dhingra L, Ahmed E, Shin J, Scharaga E, Magun M.Cognitive effects and sedation.Pain Med. 2015;16 Suppl 1:S37–S43. doi:10.1111/pme.12912Merck Manual: Professional Version.Neuropathic pain.The University of California, UCSF Health.Trigeminal neuralgia.American Cancer Society.Peripheral neuropathy.The Foundation for Peripheral Neuropathy.Massage for neuropathy.Additional ReadingFornasari D.Pharmacotherapy for neuropathic pain: A review.Pain Ther.2017;6(Suppl 1):25-33. doi:10.1007/s40122-017-0091-4Gilron I, Baron R, Jensen T.Neuropathic pain: Principles of diagnosis and treatment.Mayo Clin Proc. 2015;90(4):532-45. doi:10.1016/j.mayocp.2015.01.018McNicol ED, Midbari A, Eisenberg E.Opioids for neuropathic pain.Cochrane Database Syst Rev.2013 Aug 29;(8):CD006146. doi:10.1002/14651858.CD006146.pub2
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cleveland Clinic Health Library.Neuropathic pain.International Neuromodulation Society.Neuropathy, neuropathic pain, and painful peripheral neuropathy: many kinds, causes, and treatments.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M.Peripheral neuropathy and new treatments for multiple myeloma: Background and practical recommendations.Haematologica. 2010;95(2):311–319. doi:10.3324/haematol.2009.012674Fallon MT.Neuropathic pain in cancer.Br J Anaesth. 2013;111(1):105–111. doi:10.1093/bja/aet208Campbell JN, Meyer RA.Mechanisms of neuropathic pain.Neuron. 2006;52(1):77–92. doi:10.1016/j.neuron.2006.09.021Trevelyan EG, Turner WA, Robinson N.Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: A qualitative study.Br J Pain. 2016;10(2):70–77. doi:10.1177/2049463715590884National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.Merck Manual: Consumer Version.Neuropathic pain.Eli Lilly and Company.Highlights of prescribing information.Hocaoğlu N, Murat N, Mıcılı SC, Aydın B, Ergür BU, Kalkan Ş.Correlation between amitriptyline-induced cardiotoxic effects and cardiac S100b protein in isolated rat hearts.Balkan Med J. 2016;33(6):681–687. doi:10.5152/balkanmedj.2016.150435U.S. National Library of Medicine, StatPearls.Amitriptyline.Pfizer.Neurontin (gabapentin).Pfizer Parke-Davis.Lyrica-pregabalin capsule; Lyrica-pregabalin solution. Highlights of prescribing information.Vernachio K, Lovett AW, Williams J.A review of withdraw strategies for discontinuing antiepileptic therapy in epilepsy and pain management.Pharm Pharmacol Int J. 2015;3(1):232-235. doi:10.15406/ppij.2015.03.00045Harvard Medical School, Harvard Health Publishing.Going off antidepressants.Centers for Disease Control and Prevention.Preventing opioid overdose.American Society of Anesthesiologists.What are opioids.The University of Iowa, GeriatricPain.org.Side effects of opioid medications and general approaches to management.Ibrahim AM, Obaidi Z, Ruan G, Adaramola D, Onguti S.Nalbuphine for opioid-induced urine retention.Ann Intern Med. 2018;169(12):894–895. doi:10.7326/L18-0387Dhingra L, Ahmed E, Shin J, Scharaga E, Magun M.Cognitive effects and sedation.Pain Med. 2015;16 Suppl 1:S37–S43. doi:10.1111/pme.12912Merck Manual: Professional Version.Neuropathic pain.The University of California, UCSF Health.Trigeminal neuralgia.American Cancer Society.Peripheral neuropathy.The Foundation for Peripheral Neuropathy.Massage for neuropathy.
Cleveland Clinic Health Library.Neuropathic pain.
International Neuromodulation Society.Neuropathy, neuropathic pain, and painful peripheral neuropathy: many kinds, causes, and treatments.
Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2
Mohty B, El-Cheikh J, Yakoub-Agha I, Moreau P, Harousseau JL, Mohty M.Peripheral neuropathy and new treatments for multiple myeloma: Background and practical recommendations.Haematologica. 2010;95(2):311–319. doi:10.3324/haematol.2009.012674
Fallon MT.Neuropathic pain in cancer.Br J Anaesth. 2013;111(1):105–111. doi:10.1093/bja/aet208
Campbell JN, Meyer RA.Mechanisms of neuropathic pain.Neuron. 2006;52(1):77–92. doi:10.1016/j.neuron.2006.09.021
Trevelyan EG, Turner WA, Robinson N.Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: A qualitative study.Br J Pain. 2016;10(2):70–77. doi:10.1177/2049463715590884
National Institute of Neurological Disorders and Stroke.Complex regional pain syndrome fact sheet.
Merck Manual: Consumer Version.Neuropathic pain.
Eli Lilly and Company.Highlights of prescribing information.
Hocaoğlu N, Murat N, Mıcılı SC, Aydın B, Ergür BU, Kalkan Ş.Correlation between amitriptyline-induced cardiotoxic effects and cardiac S100b protein in isolated rat hearts.Balkan Med J. 2016;33(6):681–687. doi:10.5152/balkanmedj.2016.150435
U.S. National Library of Medicine, StatPearls.Amitriptyline.
Pfizer.Neurontin (gabapentin).
Pfizer Parke-Davis.Lyrica-pregabalin capsule; Lyrica-pregabalin solution. Highlights of prescribing information.
Vernachio K, Lovett AW, Williams J.A review of withdraw strategies for discontinuing antiepileptic therapy in epilepsy and pain management.Pharm Pharmacol Int J. 2015;3(1):232-235. doi:10.15406/ppij.2015.03.00045
Harvard Medical School, Harvard Health Publishing.Going off antidepressants.
Centers for Disease Control and Prevention.Preventing opioid overdose.
American Society of Anesthesiologists.What are opioids.
The University of Iowa, GeriatricPain.org.Side effects of opioid medications and general approaches to management.
Ibrahim AM, Obaidi Z, Ruan G, Adaramola D, Onguti S.Nalbuphine for opioid-induced urine retention.Ann Intern Med. 2018;169(12):894–895. doi:10.7326/L18-0387
Dhingra L, Ahmed E, Shin J, Scharaga E, Magun M.Cognitive effects and sedation.Pain Med. 2015;16 Suppl 1:S37–S43. doi:10.1111/pme.12912
Merck Manual: Professional Version.Neuropathic pain.
The University of California, UCSF Health.Trigeminal neuralgia.
American Cancer Society.Peripheral neuropathy.
The Foundation for Peripheral Neuropathy.Massage for neuropathy.
Fornasari D.Pharmacotherapy for neuropathic pain: A review.Pain Ther.2017;6(Suppl 1):25-33. doi:10.1007/s40122-017-0091-4Gilron I, Baron R, Jensen T.Neuropathic pain: Principles of diagnosis and treatment.Mayo Clin Proc. 2015;90(4):532-45. doi:10.1016/j.mayocp.2015.01.018McNicol ED, Midbari A, Eisenberg E.Opioids for neuropathic pain.Cochrane Database Syst Rev.2013 Aug 29;(8):CD006146. doi:10.1002/14651858.CD006146.pub2
Fornasari D.Pharmacotherapy for neuropathic pain: A review.Pain Ther.2017;6(Suppl 1):25-33. doi:10.1007/s40122-017-0091-4
Gilron I, Baron R, Jensen T.Neuropathic pain: Principles of diagnosis and treatment.Mayo Clin Proc. 2015;90(4):532-45. doi:10.1016/j.mayocp.2015.01.018
McNicol ED, Midbari A, Eisenberg E.Opioids for neuropathic pain.Cochrane Database Syst Rev.2013 Aug 29;(8):CD006146. doi:10.1002/14651858.CD006146.pub2
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