I received a very nice email today from a new club member (Peripheral Neuropathy Sufferer) who asked a great question. "Is there any prescription drugs that I am not on that I should be on?" While I again told him I am not a physician, I did give him a quick run down of what I have found beneficial personally and what is out there (as stated by current medical organizations in the field). I do want to point out to everyone that Peripheral Neuropathy is a quickly growing field as there are so many suffers, and therefore, many new treatments coming out here and there. This article will be based on the tried and true pharma regimens.
Opioids and Other Pain Killers
As stated in a prior article, depending on your pharma regimen, you may also want to always make sure you have some pain management medications to address those flare-up conditions. While I was on Opioids for the first year of my diagnosis (also recouping from surgery and chemo) I do not take them in my daily regimen. However during the winter months I do end up taking a few here and there to get over a winter flare-up. I am most defiantly not pushing Opioids, as well we all have heard of the problems with them, but if you know you can handle them okay without building an addiction, they are a good "flare-up" choice. One alternative I will always try first is alternating Acetaminophen (Tylenol) with Ibuprofen (Advil) every 2-3 hours. As they are different classes of drugs, just make sure to not take over the daily recommended amount.
What are Opioids you may ask? This is a another great question because the Nightly News only seems to talk about the "Opioid Epidemic" but does not give us more information on what this entails. The Department of Health and Human Services (HHS) defines Opioids as a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. There is many questions as to whether these drugs can substantially help neuropathic pain suffers and there has even been studies done by the National Center for Biotechnology Information (NCBI) which do question this. The Pharmacy Times stated in April 2017 that "Many opioids, including morphine, oxycodone, fentanyl, tramadol, tapentadol, methadone, and levorphanol, have shown efficacy in peripheral neuropathic pain; however, only tramadol, tapentadol, methadone, and levorphanol have well established mechanisms that substantially reduce neuropathic pain." I have tried tramadol personally to no positive effect and while I have talked to some who stated it does help them, because I know I can tolerate the addictive sides of opioids, I will stick with them only for the flare-ups as needed.
Gabapentin
Gabapentin is an anti-epileptic drug, also called an anticonvulsant. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. This has also shown substantial improvement in neuropahtic pain and one that I take myself at the maximum dose of 1,800 mg daily (divided into 3 daily doses). If I miss a dose, I will end up feeling it pretty quickly in general overall pain in my feet.
Cymbalta (Duloxetine) and Lyrica (Pregabalin)
Cymbalta, Lyrica, and now Lyrica CR are drugs that have been approved by the FDA for nerve pain associated with neuropathy. Cymbalta is a prescription medicine used to treat a certain type of depression called Major Depressive Disorder (MDD). Cymbalta belongs to a class of medicines known as SNRIs (or serotonin-norepinephrine reuptake inhibitors). Lyrica (pregabalin) is an anti-epileptic drug (anticonvulsant) used for neuropathic (nerve) pain associated with diabetic peripheral neuropathy or postherpetic neuralgia, and for treating partial onset seizures in adults, and fibromyalgia. I personally take Cymbalta at 60 mg daily, and again if I miss a day I will defiantly feel it the next (feels like someone ran a stake through my feet). The mood lift is just a bonus :P
Topical Pain Relievers
Nonprescription topical pain relievers (analgesics) which are rubbed on the skin are available to treat pain from neuropathy. These medications contain capsaicin (Capzasin-P®, Dolorac®, Zostrix® are brand names). Look at your local drugstore for a off brand creams containing caspacin which will be cheaper, but be careful when putting it on! It will heat or burn what it touches!
Supplements
Okay much more coming on supplements later as there are a number which the NCBI has actually done studies on and proven that they have an impact. The main ones you want to look into now are a good B-Vitamin, Alpha-lipoic acid and Acetyl-L-carnitine. B vitamins are useful in treating neuropathy since they support healthy nervous system function. Peripheral neuropathy is sometimes caused by a vitamin B deficiency. Alpha-lipoic acid is an antioxidant that may be useful in treating neuropathy caused by diabetes or cancer treatment. It’s said to lower blood sugar levels, improve nerve function, and relieve uncomfortable symptoms in the legs and arms. Acetyl-L-carnitine is an amino acid and antioxidant. NOTE: If you are on blood thinners consult your doctor before taking Acetyl-L-carnitine, with some blood thinners, it may increase the risk of bleeding.
I am going to add the three I use from Amazon as they are a good price, potency and right dosage. Remember if you purchase off these links, our friends at Amazon give us a small fee which goes to keeping the website running.
Again, there are various non-pharma treatments out there. I have gone to physical therapy and progressed in my balance to get off a cane and walker over time, albeit still use both at times. I have heard so so results from different forms of electric stimulation, etc. However this gave my new friend a good overview of what to look for and expect by way of a pharma regime. Remember always consult your treating physician and make sure they know about any supplements you take!
Take care and bundle up!
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