Any alternatives...?

Symptoms and treatments
1

Are there any other options for neuropathic pain medications other than the usual suspects of
Gabapentin / Pregabalin / Amitriptyline / Duloxetine?

These seem to be the only 4 ever mentioned in relation to nerve pain. The first one kind of works but is a b***** for weight gain, and the other three just made me feel very unwell.

Is it really a choice between putting on undesirable amounts of weight or feeling so unwell that the cure is worse than the problem?

2

Yes, there are other medications that can be used to treat neuropathic pain, beyond the four you mentioned. Here are a few other options:

  1. Tricyclic antidepressants: In addition to amitriptyline, other tricyclic antidepressants such as nortriptyline and desipramine may be effective in treating neuropathic pain.
  2. Serotonin and norepinephrine reuptake inhibitors (SNRIs): In addition to duloxetine, other SNRIs such as venlafaxine and milnacipran can also be used to treat neuropathic pain.
  3. Topical medications: Some topical medications, such as lidocaine patches or capsaicin cream, can be applied directly to the affected area to help relieve pain.
  4. Opioids: While not typically a first-line treatment for neuropathic pain due to their potential for addiction and side effects, opioids may be considered for patients who do not respond to other treatments.
  5. Anticonvulsants: In addition to gabapentin and pregabalin, other anticonvulsants such as carbamazepine and lamotrigine may also be effective in treating neuropathic pain.

It’s important to work closely with your healthcare provider to find the medication or combination of medications that work best for you, while minimizing side effects. They may also recommend non-pharmacological approaches, such as physical therapy or cognitive behavioral therapy, to help manage your pain.

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3

I use cannabis for pain with a Vaporiser because I don’t smoke, it’s amazing for pain but I have tried CBD Oil which helped with pain but for me cannabis is better to control pain

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4

I can vouch for capsaicin cream for stabbing neuropathic pain. It worked as well as carbamazepine but without knocking me sideways. The one the GP prescribed was called Axsain, I think. It’s a topical rather than systemic so no side effects beyond having to be careful to keep it away from sensitive parts on account of it’s made of :hot_pepper:.

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5

Hi, I’m new to the forum so apologies if I’m not doing it right. I’ve had R/R MS since 2000 and always had moderate-level 24/7 neuropathic pain (burning and numbness) in my hands, arms and feet. In the last couple of weeks I have got a very large area of skin on my right hand side at midriff height that is really painful to touch even slightly. It’s been suggested it may be a flare up rather than a relapse so steroids wouldn’t be offered. It’s not shingles as I’ve had the jabs and there’s nothing visible on the skin. Does anyone have experience of this and is there anything I could use or take. I’ve used Biofreeze which although for muscles offers some relief. Also I’m on Gabapentin and Sertraline (antidepressant). Do you think lidocaine or capsaicin would help this type of skin pain. Thanks

6

I have had good results with capsaicin ointment for stabbing neuropathic pain.
I have never tried it on the can’t-bear-to-be-touched sort, but it’s got to be worth a try. For me, those kind of pains are made much worse by overheating, so keeping core temperature down is key for me, and if it’s a bit of me that I can run under a cold tap, that’s what I often do. Cold showers are helping me in this weather too (as well as lots of other things to help manage the bad effects of the hot weather).

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Thank you so much for your detailed reply. I will give capsaicin a try especially as my ms team declined steroids as it is “only a flare up”.
Whatever it’s called it’s really painful so thank you for taking my post seriously.

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8

I got Axsain ointment and it’s prescription only - stronger than the stuff you can get otc.

9

I assume they mean that you have the kind of pseudo-exacerbation that causes a temporary worsening of symptoms on account of illness, stress, overheating or whatever and that resolves to whatever your new baseline is when that aggravating factor is removed. This makes sense: steroids are strong meds and no one in his right mind wants to take them without being sure that the risk:benefit ratio looks worth it, and you know about that already, of course. But if you think you being fobbed off, please do keep asking them the question.

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Hi Allison, I just ent to the GP and had tests for infections that were negative. I’m going to see how it goes. I’ve found biofreeze helps a lot as does wearing loose clothing.
Thank you for your wise insights.

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11

Capsaicin is out of production as the manufacturer went bust. They’re talking of new supplies in 2026!!

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12

Oh that’s bad news! Sorry to hear it.

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13

Neuropathic pain is my worst symptom. I have been prescribed many different anti-convulsants over the years, most of which are horrendous for weight. You could ask your neuro about topiramate, which can cause weight loss, and works (to some extent) for my nerve pain (I have trigeminal neuralgia and it works a treat - but does not touch other neuro pain, which I have in my feet).

I would also ask to be referred to a pain clinic, although waiting lists are very long. A few years ago I underwent both lidocaine and ketamine infusions, in an effort to ease the constant burning pain in my feet. While the ketamine infusion made me feel fantastic for an hour, there were no long lasting effects.

I hope you get some relief x

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