24 Oct Pain Doctors Treat Neuropathic Pain
Neuropathic pain is difficult to treat. To date there are no proven treatment methods or cures for neuropathic pain so the primary goal is to reduce pain as much as medication and other therapies can. The focus is to balance the good of the medications and treatments against negative side effects and to teach patients how to manage the pain that has not been resolved.
The treatment of nerve pain is usually done with various medications and nerve blocks. It can also include implantable systems. Physical therapy, transcutaneous electrical nerve stimulation or TENS, occupational therapy and psychological therapy are all options pain doctors have at their disposal to help you cope with pain.
Neuropathic pain is complex and generally requires pain doctors to take a multi disciplinary and integrated approach to obtain the best pain management results. If you are dealing with chronic neuropathic pain, your pain doctors might include you working with a spine specialist or neurologist to help manage your pain. Physical rehabilitation with an occupational therapist or physical therapist can also be used to aid with physical rehabilitation exercises and to strengthen the supporting muscles.
Because of the intensity of neuropathic pain, your pain doctors will usually use medications as their first line of treatment. However, that may still take some time, as trial and error is a large part of finding the medications that work because each person’s response to these medications is very different.
Types of Medications Used to Treat Neuropathic Pain
There are three main types of medications that are used in the treatment of nerve pain, although your pain doctors may choose to use others as well.
Anticonvulsants, which are also called neuroleptic medications, include drugs like felbamate, carbamazepine, clonazepam, valproic acid, and Phenytoin. One of the newer drugs gabapentin (Neurontin) is showing great success, and it is well tolerated by most patients.
Antidepressants especially tricyclic antidepressants like Nortriptyline or Amitriptyline work well for reducing nerve pain and helping patients to sleep. They are given at much lower dosages than what would be administered for treating depression. The newer class of SSRI antidepressants do not seem to have the same effect.
Pain medications including NSAIDs, opioid analgesics like morphine are not overly effective in reducing or eliminating most neuropathic pain, so they are not usually the third line of defense with anticonvulsants and antidepressants being the first choice. Often it is a combination of all three medications. Opioid analgesics may work at high dosages.
Nerve Blocks for Treatment of Neuropathy
A nerve block is simply an anesthetic injection direct to the affected nerve area. The purpose for a nerve block is to interrupt the pain transmission signal to the brain, thereby bringing some relief to the sufferer. If the pain signal cannot reach the brain then you will not feel the pain.
Injections can include local anesthetics, steroids, and opioids. Local anesthetics break the pain cycle and offer the patient some relief. Steroid injections decrease inflammation and thereby decrease the nerve irritation so pain is decreased. Opioid injections can offer highly effective short-term relief from pain.
There are a number of other less conventional treatments that are sometimes used.