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 without needing a specific stimulus, or in response to something that wouldn’t normally hurt, such as gentle stroking of your skin.

This is sometimes caused by:

Pain from nerve damage can be very severe. It may respond to stronger opioids but occasionally other drugs are used:

Amitriptyline

Amitriptyline is an antidepressant drug but at lower doses it's widely used for long-term pain caused by arthritis, nerve pain or fibromyalgia.

You'll usually start on 5–10 mg and gradually increase the dose. Dosage 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. Some people can’t tolerate even low doses.

Because it can make you feel sleepy, it's best to take it about two hours before you go to bed.

The side-effects of amitriptyline are:

  • drowsiness
  • a dry mouth.

You shouldn’t take amitriptyline if you have:

  • certain forms of glaucoma
  • heart rhythm problems.

Gabapentin, pregabalin and duloxetine

Gabapentin, pregabalin and duloxetine can also be effective for nerve pain.

Like amitriptyline, they may be given alongside 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
  • weight gain. 
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