Which drugs can be used for nerve (neuropathic) pain?

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Nerve pain can be caused by damage to your nerves or nerve endings. This causes your nerves to send pain signals to your spinal cord spontaneously, without needing a specific stimulus, or in response to something that wouldn’t normally hurt, such as gentle stroking of your skin. This sometimes happens in complications from diabetes and in some people with sciatica and complex regional pain syndrome (reflex sympathetic dystrophy), as well as rheumatoid arthritis.

Pain from nerve damage, for example the pain that’s caused by spinal problems or that follows a bout of shingles, can be very severe and troublesome. This pain may respond to stronger opioids but occasionally other drugs, including amitripyline, gabapentin, pregabalin and duloxetine are used.

Amitriptyline

Amitriptyline is an antidepressant drug but at lower doses it's widely used to relieve long-term (chronic) pain associated with arthritis, nerve pain or fibromyalgia. Because it has a sedative effects it's best taken about two hours before going to bed. Usually you'll start on a dose of 5–10 mg and gradually increase it. The dose is usually capped at 50 mg a day if you’re only using it for pain relief, but your doctor may suggest a higher dose (e.g. 75 mg) if the pain is very severe and disturbs your sleep.

Amitriptyline causes drowsiness and a dry mouth, and some people can’t tolerate even low doses. You shouldn’t take amitriptyline if you have certain forms of glaucoma or heart rhythm problems.

Gabapentin, pregabalin and duloxetine

Gabapentin, pregabalin and duloxetine are also drugs which can be effective for nerve pain. Like amitriptyline, they may be given in combination with other pain medications in the most troublesome nerve pain conditions. Duloxetine is licensed for pain from nerve damage resulting from diabetes, which most often starts in the feet.

The most common side-effects are sleepiness, dizziness and weight gain. 

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