Treatment and Medication Options for Peripheral Neuropathy
A wide variety of treatments and medications for neuropathy is available. However, their success depends on the type of nerve damage and the severity of symptoms, according to the FPN.
Medication Options
Williams says antidepressant and anti-seizure medications are “the types of categories we’re likely to turn to and can be most helpful.” This is because they act on pain from abnormal nerve firings or nerve signals.
“Antidepressants have an effect on some of the neurotransmitters like norepinephrine and serotonin, which can have an effect on pain,” he explains.
Williams notes the following antidepressant options that may help treat neuropathy:
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), which restore the chemical balance in the nerve cells of the brain
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor), which inhibit the production and release of specific neurotransmitters, including serotonin and norepinephrine
- Norepinephrine reuptake inhibitors (NRIs), which inhibit the reuse of the neurotransmitters dopamine, serotonin, and norepinephrine
- Serotonin receptor modulators, such as trazodone (Oleptro), which increase the levels of serotonin and norepinephrine in the brain available to transmit signals to other nerves
Anti-seizure medications are another class of medications that may be effective at treating neuropathy. Gabapentin (Neurontin) and pregabalin (Lyrica) are examples of anti-seizure medications that people use to relieve nerve pain due to shingles or as a result of diabetes, according to a paper published in 2019.
Common over-the-counter medications can provide some relief from mild-to-moderate neuropathic pain, according to Williams. These include:
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve)
- Topical treatments such as capsaicin and lidocaine creams
A physician might also prescribe stronger medications as well. Options include:
- COX-2 inhibitors like celecoxib (Celebrex)
- Opioids
- Tramadol (Ultram)
Surgery
As mentioned, Highlander says surgery can be useful to release pressure on a nerve and may help to treat damage that occurs due to carpal tunnel syndrome and diabetic neuropathy.
Nerve Stimulation
Neuromodulation is another option. It can involve placing an electrode along a peripheral nerve. “These are helpful by essentially turning off pain signals,” explains Williams. “You can do that very selectively with individual peripheral nerves or you can take a more regional approach with spinal cord stimulation.”
Alternative and Complementary Therapies
Research into alternative therapies for neuropathic symptoms has shown some noteworthy results.
Cannabidiol (CBD)Derived from the same cannabis sativa plant that producesmarijuana and hemp, cannabidiol has been used in the treatment of chronic, noncancer neuropathic pain, but more studies are necessary to prove that it’s effective. A small, randomized, controlled clinical trial that was published in 2020 found that “there was a statistically significant reduction in intense pain, sharp pain, and cold and itchy sensations in the CBD group when compared to the placebo group.” However, a study published in 2023 found no significant difference in neuropathy pain relief effects between cannabis-derived medicines and a placebo.
Alpha Lipoic Acid The antioxidant has been used to treat diabetic neuropathy at Houston Methodist Hospital in Houston, says Dr. Smith. It is a naturally occurring fatty acid found in foods, such as spinach, broccoli, yams, and potatoes. In a review of eight placebo-controlled studies published in 2022, three of them found that alpha lipoic acid reduced symptoms, but five found no significant difference. The most common method of delivery in these studies was injection, and the most common dose was 600 mg per day. However, all of the studies concluded that alpha lipoic acid was safe and that people tolerate it well, reporting no side effects.
Carnitine Another fatty acid, this is sometimes deficient in people with neuropathy, resulting in an insufficient blood supply to nerves. The body makes all of the carnitine that it needs in healthy children and adults, so it is not necessary to get more from supplements or nutritional sources such as meat, poultry, and dairy.
However, supplementing in its fatty acid form, known as acetyl-L-carnitine, can help treat neuropathy, says Smith. A systematic review published in 2019 singled out acetyl-L-carnitine as effective for people with diabetic neuropathy.
Curcumin Curcumin, the active chemical in turmeric, has demonstrated benefits for people with diabetic neuropathy. A review published in 2018 found that circumin might reduce the risk of several diabetes complications, including neuropathy. However, a paper published in 2023 concludes that most studies testing the effects circumin on diabetes complications took place using animals and individual cells. More human studies could help to demonstrate curcumin’s potential for reducing peripheral neuropathy risk.
