A pinched nerve can cause nerve pain in many places in the body. Two of the more common ones are low back pain from sciatica and pains in the hand and sometimes wrist from carpal tunnel syndrome. Sciatica usually goes away without surgery by using intravenous colchicine (see chapter 14 of Pain Free 1-2-3), and carpal tunnel syndrome usually resolves after 6 to 12 weeks with vitamin B6 (250 mg a day), thyroid hormone, and wrist splints (see chapter 19).
Reflex Sympathetic Dystrophy (CRPS)
This usually manifests as horribly severe pain in one hand or foot but can certainly spread elsewhere. See the end of this chapter in the Pain Free 1-2-3 book for a detailed discussion on effective treatment.
How Can I Make the Neuropathic Pain Go Away?
Neuropathic pain occurs biochemically, making it a very fluid system that can often be quickly modified, resulting in pain relief. Many different chemicals (neurotransmitters) in your body may be involved in your pain, and therefore it is worth trying different types of medications to see which ones work best in your case. For many, treating the nutritional and thyroid deficiencies and eliminating the muscle spasms, which are compressing your nerves, may be enough to eliminate your pain. Others may need to take medications to suppress the pain while we look for ways to eliminate the underlying cause. The best way to tell which chemicals are involved in your nerve pain is to simply try different medications (individually and, if needed, in combination) to see what eases your pain. Basically, it is like trying on different shoes to see what fits best. The good news is that we have a large assortment of "shoes" that you can try on and that are likely to help you.
It is, of course, critical to begin by eliminating the underlying causes of neuropathy and giving the nerves what they need to heal. This includes the nutritional support we've discussed. In addition, the involvement of free radicals in nerve excitation was found in 1995, supporting the use of antioxidants in nerve pain. Since that time, the antioxidant lipoic acid (300 mg 2 times a day) has been shown to be helpful in diabetic neuropathy and should be tried in other neuropathies as well. You will be amazed at how much benefit you may get over time simply from optimizing nutritional support.
In addition, if you are tired, cold intolerant, experience achiness, have low body temperatures, or have weight gain I think it is reasonable to consider a therapeutic trial of natural thyroid hormone regardless of your blood levels. It may take 3 to 6 months for the thyroid and/or nutritional therapies to begin working, but regardless of the cause of your neuropathy, this treatment may result in nerve healing. It is reasonable to begin medications along with the nutritional support so that you can get pain relief as quickly as possible. If only a small area is involved, it makes sense to begin with a Lidocaine® patch (called Lidoderm). Otherwise, I prefer to begin with Neurontin® and/or tricyclic anti-depressants. All of the recommended oral nutrients discussed earlier, except lipoic acid, Acetyl-L-Carnitine, and the 1,600 unit mega dose of vitamin E, are contained in the Energy Revitalization System vitamin powder and B-complex. For carpal tunnel syndrome, add 200 mg of B6 to the powder.
Below are just some of the different categories of prescription treatments that can be helpful for nerve pain. They (along with the natural treatments) are discussed in more detail in my book Pain Free 1-2-3. Begin with the nutritional and thyroid support as noted above. You can then add the medications below as needed in the order that they're listed.
- Lidocaine® patch, 5%. This Novocain®-like patch is applied directly over the area of maximum pain. It can be cut to fit the area, and up to four patches can be used at a time (although the package insert says only three). It is left on for 12 hours and then removed for 12 hours each day, although recent reports have suggested that the patch can be left on up to 18 hours and still be safe and effective. Results will usually be seen within two weeks. Because the effect is local, side effects are minimal. The most common side effect is a mild skin rash from the patch. It should not be used if you have an allergy to Novocain/lidocaine. The patches are most likely to be helpful if the pain is localized to a moderately sized area. Even in a large area, however, patches can be used on the most uncomfortable spots. The main downside of the patches is that they are expensive. If you have prescription insurance, however, they will usually be covered.
- Neurontin® and other seizure medications. Newer anti-seizure medications, and some of the older ones, can also be very helpful for neuropathic pain. Neurontin has been shown to be helpful for both shingles and diabetes pain. Common side effects include sedation, dizziness, and sometimes mild swelling in the ankles when first starting therapy. These side effects can often be avoided by starting with a low dose and raising the dose slowly. A common total dose for Neurotonin is 600 mg, 3-4 times a day.
- Tricyclic anti-depressants. These include medications such as Elavil®, Tofranil®, nortriptyline or doxepin.
- Topical Gels. A wonderful new addition to the treatment of pain in general, and especially nerve pain, is the use of prescription topical gels. New gels have been developed that markedly increase the absorption of medications through the skin. By using a low dose of many different medications in the cream, one can get a powerful effect locally with minimal side effects. It is best to have a knowledgeable compounding pharmacist (e.g., ITC Pharmacy 303-663-4224) guide you and your physician in the prescribing of these creams and gels. To explore an example of how to treat with these creams combined with nutritional support, let's use the example of diabetic neuropathy. One must, of course, begin with proper control of the elevated blood sugars. Nutritional support with high levels of vitamin B12, B6, and inositol are also important in diabetic nerve pain as are many other nutrients, such as vitamins C and E, magnesium, antioxidants and bioflavonoids (all in the Energy Revitalization System). In addition, lipoic acid 300 mg 2 times a day has been shown to be helpful for diabetic neuropathy. A compounded gel containing (as one of many possible mixes) Ketamine 10%, Neurontin® 6%, clonidine 0.2%, and nifedipine should be added to painful areas (apply 1 g 3 times a day as needed). The nutritional support can actually make the pain go away over time, while the cream/gel can add symptomatic relief. Other medications discussed in this chapter can then be added as needed to assist in the neuropathic pain.
- Anti-depressants such as Effexor or Cymbalta.
- Ultram (Tramadol®). This is an interesting medication that works on many areas of pain and in many different types of pain. It has been shown to be effective for nerve pain in a placebo-controlled study after four weeks.
- Topamax (Topiramate®)
- Lamictal (Lamotrigine®)
- Lyrica (Pregabalin) or Gabitril (Tiagabine®)
- Keppra®
- Trileptal® (oxcarbazepine)
- Dilantin®
- Capsaicin®
- Narcotics. Narcotics are only modestly helpful but are considered an accepted treatment for neuropathic pain.
- Benadryl® (diphenhydramine). Sometimes we get help from unexpected places. Studies have shown in both humans and animals that antihistamines can help pain—in spite of our not knowing why this works. It has even been found to be helpful in patients who failed treatment with heavy narcotics. It is recommended that you start with 25 mg every 6-8 hours and adjust the dose to the optimum effect.
Most people find that long term the nutritional and topical therapies will eliminate or at least give marked relief from their nerve pain. For immediate control, 1-2 medications by mouth are usually enough, but I give this long list (and more treatments are discussed in my book) so that you know that you have options and can get pain free. To find a physician who knows how to treat pain, see the American Academy of Pain Management website.
Even with severe nerve pain, you can get pain free now, using the best of natural and prescription therapies!
