Sometimes, treating the underlying cause doesn't relieve neuropathic pain, or no underlying cause can be found. In these cases, doctors prescribe medications to relieve neuropathy symptoms. Antidepressants (tricyclics and SNRIs) and anticonvulsants are considered first-line treatments for neuropathy pain.
SNRIs (serotonin-norepinephrine reuptake inhibitors) like Cymbalta (duloxetine) and Effexor (venlafaxine) and tricyclics like Elavil (amitriptyline) work by blocking proteins that act as re-uptakers, thereby increasing serotonin and norepinephrine levels. No one knows why, but patients with chronic pain often have low levels of these neurotransmitters. Therefore, taking drugs that increase these agents can be effective in decreasing pain. SNRIs are a newer class of drugs and have fewer side effects than the older tricyclics.
Anticonvulsants like Gabapentin prevent calcium from entering neurons and triggering a biochemical reaction that can result in neuropathic pain [source: Jeffries]. Studies show that about 43 percent of neuropathy patients who took Gabapentin at doses of 1200 milligrams or more showed moderate improvements, and one in three patients showed a substantial benefit [source: Moore, Wiffin, Derry and McQuay]. Gabapentin's main side effects are drowsiness, dizziness and diarrhea.
Neither tricyclics nor SNRIs work in every case. For cases where medications don't work or aren't effective enough, topical treatments may also be indicated. We discuss those next.