Treatment of Neuropathy

The tricyclic antidepressant amitriptyline (Elavil) and topical capsaicin (the active ingredient in hot peppers) are commonly used for neuropathy pain. Other antidepressants are also showing promise for relieving pain and numbness, including sertraline (Zoloft) -- a serotonin reuptake inhibitors (SSRIs) -- and nefazodone (Serzone), a newer antidepressant. Both have fewer side effects than the tricyclic. The anti-seizure drug gabapentin (Neurontin) may be as effective as amitryptyline, although it is more expensive.

Tramadol (Ultram), a pain killer that is similar to opioids, achieved moderate pain reduction in one study and may have fewer side effects than anti-seizure drugs or tricyclics, although it carries a risk for addiction and nausea, headache, and constipation are common. Investigators are also testing nerve-growth factor, which promotes nerve survival. In one study, patients taking it experienced both greater sensation and dramatically reduced levels of pain and discomfort. The only side effect was discomfort at the injection site.

Vitamin E supplements may be helpful. If foot pain, numbness, or tingling is worse at night, diphenhydramine (Benadryl) may help. Delayed stomach emptying caused by neuropathy may be helped by erythromycin or metoclopramide (Reglan).

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