What Are Neuropathy Pain Medications?
There are many different types of pain, and all pain is propagated along nerves. Nerves pass on pain signals from pain receptors (nociceptors) where the signal is provoked and initiated, ultimately to the brain, where all pain is perceived. In between are all of the peripheral and spinal nerves. Where neuropathy is involved will affect how the pain is perceived. The type of neuropathy and the pain syndromes caused are the basis for a rational medication approach. When the protocol individualized for a patient involves multiple drugs, this is referred to as “rational polypharmacology,” and is best prescribed by specialists trained in pain management.
Medication can affect nerves in many ways.
- Medications can be used to lessen the severity of pain signal transmission, or at least slow them down. Anticonvulsants such as gabapentin and pregabalin are used in this respect.
- Medication can be used to raise the pain threshold of nociceptors, making them harder to fire off. Botunlinum A toxin is a drug that can do this.
- Antispasmodics are used when muscle spasms result from overtaxing muscle fibers, as happens when a patient “splints” themselves away from painful postures using infrequently used muscles constantly until they become hypoxic, acidotic, and cramp.
- Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, celecoxib, and other COX inhibitors, interfere with cyclooxygenase (COX) manufacture of a powerful pain mediator, prostaglandin. When COX-1 or COX-2 reactions are diminished, there is less prostaglandin and less pain.
- Some antidepressants prevent the re-uptake of serotonin and norepinephrine, neurotransmitters whose constant levels will help reduce pain due to their inhibitory properties. The tricyclic antidepressants (amitriptyline) and the SSNRIs (selective serotonin and norepinephrine re-uptake inhibitors, such as duloxetine and venlafaxine) do this.
- Ziconotide, made from a snail toxin, has the ability to stop chronic pain, including that of neuropathy, at the spinal level. It must be placed directly into the spinal fluid, so its delivery involves an implantable pump that requires periodic refilling.
- Narcotics, which offer the benefits of the most potent pain relief, but the disadvantages of tolerance build-up and addiction, are reserved for those in whom no other protocols are helpful. Alternately, they can be used sparingly in those who do benefit from conservative medications, but who “break through” with occasional pain spikes that impair their functionality.
Rational polypharmacology often takes advantage of the dual approach for both peripheral and central control of neuropathic pain.