Peripheral Neuropathy
Medication

Your physician may order a medication to help manage the pain and discomfort associated with peripheral neuropathy. Some of the medications that might be prescribed include:

Lidocaine patch
Anticonvulsants
Opioids
Selective Serotonin and Norepinephrine Reuptake Inhibitors
Systemic and local anesthetic agents
Topical capsaicin
Tricyclic antidepressants

Lidocaine patch 5% (Lidoderm^®) - this drug is a local anesthetic agent. Not only does it help stop the pain, it also protects the skin by preventing rubbing, which can cause discomfort.

The patches are usually well tolerated. Occasionally, the patch can cause irritation and swelling to the skin. This usually goes away when the patch is removed.

Anticonvulsants - although this class of drugs is used for the management of seizures, they are also helpful in the management of peripheral neuropathy. The most commonly used drug is gabapentin (Neurontin^®). Other drugs in this class used to manage peripheral neuropathic pain include pregabalin (Lyrica^®), phenytoin (Dilantin^®), carbamazepine (Tegretol^®), lamotrigine (Lamictal^®), and valproic acid (Depakote^®).

There are side effects associated with some of these drugs. Many of the drugs in this category cause dizziness and sedation. Gabapentin can also cause swelling in the hands and feet.

Opioids (narcotics) - based on recent research studies, opioids have been found to be helpful in the management of neuropathic pain. Some of the long-acting opioids include methadone, sustained-release morphine (MS Contin^®), sustained-release oxycodone (Oxycontin^®), or transdermal fentanyl patch (Duragesic^®). Your doctor may chose to combine an opioid with one of the other drugs known to manage neuropathic pain such as gabapentin. Tramadol (Ultram^®) is a weak opioid that also shares some of the properties as the tricyclic antidepressants. This drug can be used to manage neuropathy pain when other drugs such as the tricyclic antidepressants or the anticonvulsants are not stopping the pain. This drug can cause nausea and sedation.

There are side effects associated with opioids including constipation, itching, difficulty urinating, dry mouth, and drowsiness.

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs) - although this class of drugs is also used for the management of depression, they are also helpful managing neuropathic pain. The newest drug used to manage neuropathic pain is duloxetine (Cymbalta^®). There are side effects associated with SSNRIs including constipation, decreased appetite, dizziness, dry mouth, fatigue, increased sweating, loss of strength or energy, and sleepiness.

Systemic and local anesthetic agents (medications that numb an area of the body) can reduce the number of impulses being carried by nerve fibers. Mexiletine is a medication taken by mouth that helps alleviate pain due to neuropathy in some patients. The drug can cause an upset stomach, so it needs to be taken with food. This medicine cannot be used in people who have a heart condition.

Side effects of mexiletine includes heartburn, nausea, and lightheadness.

Topical capsaicin the active substance in hot chili peppers, is thought to provide some relief in for neuropathic pain. Capsaicin frequently causes a burning sensation at the application site. If your pain is due to herpes zoster, then your doctor may prescribe Zostrix^® cream to apply to the painful site. This cream is a form of capsaicin. It is very important to wash your hands after applying this medication. When using capsaicin, it is also important to avoid touching your eyes or genitals after applying the medication.

Capsaicin may cause a warm, stinging, or burning feeling at the place of treatment.

Tricyclic antidepressants - although this class of drugs is used for the management of depression, they are also very helpful in managing neuropathic pain associated with peripheral neuropathy. The most commonly used drug is amitriptyline (Elavil^®).

Side effects to watch for with a tricyclic antidepressant include sedation, dry mouth, constipation, difficultly remembering and concentrating, low blood pressure, sweating, and urinary retention.

Peripheral neuropathy affects many patients with cancer. It can have an impact on your quality of life. If you begin to experience any of the symptoms of peripheral neuropathy, letting your healthcare provider know is important. Your healthcare provider will work with you to find the right medications to manage the pain sometimes associated with peripheral neuropathy and will teach you strategies to adjust to the sensory changes, to keep you safe and to maximize your comfort.