Best drugs for neuropathy

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

I'm not a neurologist so my focus here will be on the way I tend to manage the neuropathy seen with my arthritis patients. Before discussing specific drugs, it is important to focus on the goals of treatment.

The goal of treatment is to identify and treat the underlying cause, minimize symptoms, help the patient to maintain their ability to perform activities of daily living, and to cure it if possible. The first steps are to treat the underlying medical problem (eg., diabetes) or remove the cause (eg., alcohol). Another step is to identify any potential drug-induced causes of neuropathy.

Physical therapy and occupational therapy can be of great help. Exercises and retraining increase muscle strength and control. Various appliances such as wheelchairs and braces improve mobility.

Weakness and reduced sensation increase the risk for falls. People with decreased sensation as a result of sensory neuropathy should check their feet or other involved areas for open cuts or other injuries which may become infected.

Other safety measures include railings, removing obstacles such as loose rugs, and other measures including adequate lighting (including lights left on at night), testing water temperature before bathing, use of protective shoes (no open toes, no high heels, and so on. Shoes should be checked often for rough areas that can injure the feet.

People with neuropathy (especially those with polyneuropathy or mononeuropathy multiplex) are prone to nerve injury at pressure points such as the knees and elbows.

A variety of over-the-counter and prescription medications may be needed to control nerve pain. Anticonvulsants (phenytoin, carbamazepine, gabapentin), tricyclic antidepressants, or other medications may be used to reduce the pain that some people experience. Lyrica is a gabapentin like drug that works well for the treatment of neuropathic pain.

A patch containing lidocaine, a local anesthetic (Lidoderm) may be helpful for localized pain.

Narcotics should be avoided when possible.

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