Neuropathic Pain Medicines

Name: Neuropathic Pain Medicines
Creator: Dr Zamiel Hussain

Neuropathic pain is caused by irritation, damage, or dysfunction of the nervous system. It is different from inflammatory or mechanical pain and often requires different treatment approaches.

Neuropathic pain is commonly described as:

Burning
Tingling
Shooting or electric shock-like
Numbness with discomfort
Hypersensitivity to touch

Common causes include:

Diabetes-related nerve damage
Post-herpetic neuralgia (after shingles)
Sciatica
Nerve compression
Post-surgical nerve injury
Fibromyalgia
Certain neurological conditions

Correct diagnosis is important before treatment begins.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

Book a GP appointment

Why Standard Painkillers Often Do Not Work

Paracetamol and NSAIDs are often less effective for neuropathic pain because they target inflammation rather than nerve signalling.

Treatment focuses on modifying how pain signals are processed by the nervous system.

🔥 Post-Herpetic Neuralgia (After Shingles)

Post-herpetic neuralgia is nerve pain that persists after a shingles rash has healed. It occurs because the shingles virus (varicella-zoster) damages nerves.

Symptoms may include:

Burning pain in the area of the previous rash
Extreme sensitivity to touch
Occasional shooting pains

Treatment is similar to other neuropathic pain, but early treatment of shingles may reduce the risk of developing post-herpetic neuralgia.

Learn more: Shingles and Viral Skin Infections →

Common Medicines Used for Neuropathic Pain

Amitriptyline

Originally developed as an antidepressant, amitriptyline is commonly used at lower doses to treat neuropathic pain. It works by altering how pain signals are processed in the nervous system.

It is often taken at night because it can cause drowsiness.

Possible side effects may include:

Dry mouth
Drowsiness
Constipation
Blurred vision
Dizziness

Because of its sedating and anticholinergic effects, amitriptyline may not be suitable for everyone.

It is used cautiously in people with:

Heart rhythm problems
Significant prostate enlargement
Glaucoma
Older age with fall risk
Severe constipation
Certain mental health conditions

It may interact with other antidepressants and medicines affecting heart rhythm. Amitriptyline is metabolised by the liver and may not be suitable in moderate to severe liver disease.

Treatment should be started at a low dose and reviewed regularly to assess benefit and tolerability.

Individual assessment is always required before prescribing.

Duloxetine

Duloxetine is a serotonin and noradrenaline reuptake inhibitor (SNRI). It affects pathways involved in both mood regulation and pain processing.

It may be considered where neuropathic pain overlaps with low mood, anxiety, or fibromyalgia-type symptoms.

Possible side effects may include:

Nausea
Sleep disturbance
Changes in appetite
Dry mouth
Increased sweating

Duloxetine may not be suitable for individuals with:

Uncontrolled high blood pressure
Certain liver conditions
Significant kidney impairment
Concomitant use of some antidepressants
Pregnancy without specialist advice

It can also cause withdrawal symptoms if stopped abruptly.

Regular review is recommended to monitor response and side effects.

Individual suitability should always be assessed before starting treatment.

⚠️ Diabetic Neuropathy

Diabetes is the most common cause of neuropathic pain. High blood sugar levels over time can damage nerves, typically starting in the feet and legs.

Managing blood sugar is essential for preventing progression. Even with good control, nerve damage that has already occurred may not reverse completely.

Learn more: Type 2 Diabetes and Prediabetes | HbA1c Blood Tests

Gabapentinoids

Gabapentin and pregabalin are commonly used for certain types of nerve pain.

These medicines affect nerve signalling and may help reduce burning or shooting pain sensations.

However:

Some gabapentinoids are controlled drugs
They carry risk of misuse and dependence
They may cause dizziness or sedation

AccessGP does not prescribe controlled drugs.

Neuropathic pain medicines are usually started at low doses and increased gradually. This reduces side effects and allows your body to adjust. It may take 4-8 weeks to find the right dose.

Other Treatment Options

In some cases, additional approaches may be considered:

Topical treatments for localised nerve pain
Physiotherapy
Weight management
Blood sugar control in diabetes
Psychological approaches for chronic pain

Medication is usually part of a broader management plan rather than a standalone solution.

Chronic Neuropathic Pain

When neuropathic pain persists, the nervous system can become more sensitised. This may increase pain perception even after the original injury has stabilised.

Management often follows a biopsychosocial model and may include:

Gradual activity pacing
Sleep optimisation
Stress management
Psychological support
Regular medication review

Escalating doses indefinitely is rarely appropriate.

Important Safety Considerations

Medical review is important before starting neuropathic pain medicines if you:

Have kidney disease
Have heart rhythm problems
Are taking other sedating medicines
Have a history of substance misuse
Are pregnant or planning pregnancy

Sudden weakness, loss of bladder control, or rapidly worsening neurological symptoms require urgent medical assessment.

Frequently Asked Questions

1. What does neuropathic pain feel like?

Neuropathic pain is often described as burning, tingling, shooting, or electric shock-like discomfort. It differs from muscle or joint pain.

2. Do normal painkillers work for nerve pain?

Standard painkillers such as paracetamol or ibuprofen are often less effective for neuropathic pain because they do not target nerve signalling pathways.