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How these medications work

Most treatments for neuropathic pain work by changing the way that nerves transmit pain messages-either by

  • Changing the nerves' electrical potential (how readily they "fire" to send messages)
  • Changing the amount of a neurotransmitter present (a chemical messenger that "carries" the electrical transmission from nerve to nerve).

An entirely different group of drugs can help pain medications work more effectively, so your oncologist may recommend more than one drug for treating pain.

The best defense is a good offense

Fortunately, many drugs are effective in treating neuropathic pain. They can help you feel better and improve your functioning and your quality of life. The key is to work with your oncology nurse and physician-and don't be shy about mentioning any new symptoms.

Most Helpful

To date, five broad groups of drugs have proven to be most effective in treating neuropathic pain.

  • Certain types of anticonvulsants and antidepressants change the way that nerves transmit pain messages. Two types of antidepressants, SSNRIs and tricyclics, are very effective in lessening the symptoms of neuropathic pain.
  • Local anesthetics can numb pain directly.
  • Opioids (like morphine) bind to pain receptor sites to reduce pain.
  • Tramadol has a unique mode of action to relieve pain. It works like a cross between an antidepressant and an opioid but without the same side effects.
May or May Not Be Helpful

Sympatholytic agents are the only treatment currently in this category. These nonopioid drugs are injected into the spinal column. However, these drugs may have side effects on your heart rate or blood pressure.

Not Likely to Be Helpful

A class of antidepressants called SSRIs has minimal positive effects on neuropathic pain. However, other kinds of antidepressants are very effective in treating this type of neuropathy.

Antiarrhythmics have had limited success in lessening these pain symptoms.

Calcitonin is a hormone that decreases bone destruction when cancer metastasizes to the bone. No studies have shown calcitonin to have pain-relieving properties.

Dextromethorphan, a common ingredient in cough medicines, has not been proven to relieve pain.

Capcaisin, the ingredient that makes chili peppers hot, can block localized pain messages from sensory nerves. Capcaisin is available as a topical cream. It does relieve neuropathic pain from surgeries. However, it does not seem to help people with cancer.

Not Recommended

Carbamazepine, a type of anticonvulsant, is not recommended for use in older patients because it has significant side effects.

Codeine and its derivatives have not been effective in treating neuropathic pain. Other opioid pain relievers, including meperidine and mixed agonists-antagonists, have no positive effect on this type of pain.

Propoxyphene, a nonopioid narcotic, has no demonstrated effect in relieving neuropathic pain.

Phenothiazines, a group of drugs known as antipsychotics, do not help with neuropathic pain.

 

Anticonvulsants

antiseizure drugs. They help neuropathic pain by changing the way that pain messages are sent by controlling how sodium and calcium travel across the nerves.

 
 

Antidepressants

drugs that change the amount of one or more neurotransmitters present that relay pain messages to the brain

 
 

SSNRI

selective serotonin norepinephrine reuptake inhibitor = a new class of antidepressants that act on both primary neurotransmitters serotonin and norepinephrine

 
 

Tricyclics

a class of antidepressants that blocks the “recycling” (also called “reuptake”) of two neurotransmitters (norepinephrine and serotonin)

 
 

Opioids

natural or synthetic opium derivatives; opioids are a type of pain killer that works on the central nervous system

 
 

SSRIs

selective serotonin reuptake inhibitors. This class of antidepressants affects the available level of only one neurotransmitter: serotonin. This type of antidepressant is not very effective in treating neuropathic pain.

 
 

Antiarrhythmics

drugs that help the heart maintain a regular heartbeat

 
 

Antipsychotics

drugs used for treating certain types of mental health disorders, such as schizophrenia. Low doses of antipsychotics may be used to treat pain.