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Pain Free: Modern Drugs and Neuropathic PainDr. Fields is Professor of Neurology and Physiology, and Director, Wheeler Center for the Neurobiology of Addiction, University of California, San Francisco. In the past three years, Dr. Fields has served as a consultant for Neurogen and Endo Pharmaceuticals, and has served on the Speakers' Bureau for Pfizer, Abbott and Merck. During the last millenium, mankind made revolutionary advances in relieving pain. Treatment progressed from non-treatments, such as "biting the bullet," to alcohol and crude opium-based drugs, to the development of safe modern opioids, or narcotic-based painkillers, and a wide range of general and local anesthetics. At least in the developed world, most everyone has found pain relief, at one time or another, from one of these drugs. Yet despite all our advances, there is one type of pain which, until recently, could not effectively be controlled by modern medicine — neuropathic pain. Usually chronic and often devastating, neuropathic pain is the result of damage to the body's nervous system. The two most common causes are diabetes ("diabetic neuropathy") and herpes zoster ("postherpetic neuralgia" or "shingles"), an infection of the nerves by the same virus that causes chickenpox. Both cause excruciating pain. What Does Neuropathic Pain Feel Like?
Although neuropathic pain is highly variable and is felt very differently by different people, doctors can easily distinguish it from other causes of pain. There is usually some abnormality of skin sensation in the painful area and sufferers usually describe neuropathic pain as strange, unfamiliar, often as a burning sensation. It can have a sharpness or a brief shooting quality, as well as a sensation that is described as tingling, crawling, electrical.
Frequently, there is a long delay between the actual nerve injury and the appearance of pain; in fact, it is not unusual for the pain to begin at about the time a person is beginning to recover physically. Treating Neuropathic Pain
The main problem with treating neuropathic pain is that the standard array of non-narcotic analgesics [acetaminophen, aspirin, non-steroidal anti-inflammatory agents (NSAIDs and cyclooxygenase 2 inhibitors)] have little effect on neuropathic pain. Recently, however, several different classes of drugs have been developed that do help people suffering from neuropathic pain. These are:
Antidepressants
TCAs
Tricyclic antidepressant drugs, or TCAs, are the most extensively studied treatments for neuropathic pain.(22) The most commonly prescribed TCA is amitriptyline. While effective, this drug does have significant side effects,(17) including a type of low blood pressure called orthostatic hypotension. Other side effects include urinary retention, memory loss, heart problems and drowsiness. Because of these significant and potentially serious side effects, doctors normally start patients on a very low dose and increase the dosage slowly.
Desipramine, another TCA, appears to be almost as effective as amitriptyline in most studies,(13)(15) but with fewer side effects and significantly less drowsiness. SSRIs
For most types of neuropathic pain, selective serotonin reuptake inhibitors (SSRIs) are significantly less effective than TCAs, although the SSRI, paroxetine, has been reported to help pain caused by diabetic neuropathy.(21) On the other hand, SSRIs have virtually none of the side effects of desipramine or amitriptyline, and are non-sedating, that is, they don't cause drowsiness. An added benefit of SSRIs is that they are very effective at treating the depression and anxiety that sometimes afflict those with chronic pain.
Newer Drugs
Though still under study, one of the newer generation antidepressants, venlafaxine (sold under the brand name Effexor®), is a promising drug for neuropathic pain control. Like the SSRIs, venlafaxine is safer than TCAs but acts in a similar way to TCAs and, thus, seems to be more effective than other SSRIs for pain relief.(12)(16)
(7) Comments have been made Keith
Note to all: many of the pharm companies have been caught trying to market SSRI's, tca (depressions meds, anticonvulsants) as helping with neuropathic pain. They were not making enough money being sold for what they made them for so they were told to sell it any way the could. Neurotin is the most known for it. Doctors actually earned commissions from pushing it on patients. The insult to this tactic is some of these meds actually can give you neuropathy. (Just like 99% of cancer meds.) Doctors don't stress enough how bad neuropathic pain can be. You need to research yourself and always get a 2nd, 3rd, or even a 4th diagnosis/treatment. Make sure each doctor graduated from different schools to insure a true 2nd opinion. I cannot stress that point enough. Get your second opinion from a Dr. who studied medicine at a different medical school to ensure a correct diagnosis.Posted Thu, Feb. 3, 2011 at 12:51 pm EST
anonymous
To j.petersen, yes, yes, yes. Your symptoms were caused by Lipitor. It is a horrible drug. I suspect there are literally thousands of people with leg pain due to this class, statins, of drug. Very few of these cases are reported. Doctors are simply not given the full picture of the true occurrence of neuropathic pain as a side effect to these medications. I hope you have a physician who is sympathetic to your condition and believes your condition was due to Lipitor.Posted Sat, Jan. 15, 2011 at 3:00 pm EST
Joanna
My father has been struggling with neuropathic foot/leg pain for months as a result of chemotherapy for lung cancer. He has stopped treatment of the cancer, so our goal at this point is to keep him comfortable.
He is on the gabapentin, and gets little relief. He is also on heavy doses of narcotics, which affects his ability to be awake and present many days. I'm going to talk to his hospice nurse today and see if we can put him on amytryptaline. I used to take it for Migraines.
At this point we aren't really concerned with the side effects, as he is bedbound, but with adequate pain relief.
Those of you who are in chronic pain, you are in my prayers.Posted Thu, Sep. 30, 2010 at 2:56 pm EDT
william
Neuropathic pain has ruined my quality of life, my feet hurt with most all of the symptoms noted. I take Tramodol and once took just a bit to much and was in the hospital. Going to quit that and try the gabapentin, can go out in Thailand and just buy it. Hope that will be ok for me? Supposed to have few side effects. I will see, my pain is so bad.Posted Tue, Jun. 15, 2010 at 8:30 am EDT
alexa312
(USA)
Very nice site!Posted Thu, May. 20, 2010 at 11:29 am EDT
jerry petersen
Thank you for this info. I will ask my doctor about these drugs and hope for some relief as the symptoms are driving me nuts, I am firmly convinced my feet neuropathy came as a side effect of Lipitor.Posted Thu, Apr. 22, 2010 at 2:04 pm EDT
Salman Ahmed
Very informative site. Learned a lot about this disease and treatment options. Posted Thu, Feb. 11, 2010 at 10:54 am EST
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