Neuropathy, peripheral - Treating peripheral neuropathy

Treatment for peripheral neuropathy may include treating any underlying cause and any symptoms you are experiencing.

How successful treatment will be depends on the underlying cause. For example, in peripheral neuropathy caused by diabetes, ensuring your diabetes is well controlled may help improve neuropathy or at least stop it getting worse.

Treating the underlying cause

There are many different possible causes of peripheral neuropathy, some of which can be treated in different ways. For example:

• diabetes can sometimes be controlled by making healthy lifestyle changes, such as stopping smoking, cutting down on your alcohol consumption, maintaining a healthy weight and exercising regularly
• vitamin B12 deficiency can be treated with B12 injections or tablets
• peripheral neuropathy caused by a medication you are taking may improve if the medication is stopped

Some less common types of peripheral neuropathy may be treated with medication such as corticosteroids (powerful anti-inflammatory medication), immunosuppressants (medications that reduce the activity of the immune system), or injections of immunoglobulin (a mixture of blood proteins called antibodies made by the immune system).

However, the underlying cause may not always be untreatable.

Relieving nerve pain

You may also require medication to treat any nerve pain you are experiencing. The medical term for nerve pain is neuropathic pain.

Unlike most other types of pain, neuropathic pain does not usually get better with common painkillers, such as paracetamol and ibuprofen. Alternative medications are therefore usually required.

These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect. The ideal dose for each person is unpredictable, so needs trial and error. Higher doses are more likely to help your pain, but are also more likely to cause side effects.

The most common side effects are tiredness, dizziness or feeling "drunk". If you get these, it may be necessary to reduce your dose. Do not drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.

The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GP as it may be possible to change to a different medication that suits you better. Many people find the first medication they try does not suit them, so they need to try others.

Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If you are given an "antidepressant", this may treat pain even if you are not depressed and does not mean your doctor suspects you are depressed.

The main medications recommended for neuropathic pain include:

• amitriptyline – this is also used for treatment of headaches and depression
• duloxetine – this is also used for treatment of bladder problems and depression
• pregabalin and gabapentin – these are also used to treat epilepsy, headaches or anxiety

There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below.

Capsaicin cream

If your pain is confined to a particular area of your body and you can't, or prefer not to, take the medications above, you may benefit from using capsaicin cream.

Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain.

A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day.

Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment.

Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.

Lidocaine plaster

This is a large sticking plaster that contains a local anaesthetic. It is useful when pain affects only a small area of skin. It is stuck over the area of painful skin and the local anaesthetic is absorbed into the skin that is covered.

Tramadol

Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that does not respond to other treatments your GP can prescribe.

Like all opioids, tramadol can be addictive if it is taken for a long time. It will therefore usually only be prescribed for a short time. If your pain fluctuates in severity, tramadol can be useful to take at times when your pain is worse.

Common side effects of tramadol include:

• feeling sick or vomiting
• dizziness
• constipation

Treating other symptoms

In addition to treating pain, you may also require treatment to help you manage other symptoms you are experiencing as a result of peripheral neuropathy.

For example, if you have muscle weakness, you may need to have physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.

Other problems associated with peripheral neuropathy, such as erectile dysfunction, constipation, or the slow movement of food through your stomach (gastroparesis), may be treatable with medication.

In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder.