What is the best medication for nerve pain with the least amount of side effects?

2/6/2018

Here is My Question:
What's the best medication for nerve pain and one with less side effects? I have tried Lyrica, Neurotin, Cymbalta and am tapering off Amitriptyline due to weight gain.

Answer:
There are many approaches to the management of chronic neuropathic pain (nerve pain) but none of them involve only the use of drugs which, as you’ve found, are at best partially effective.

I find that a combination of mindfulness training, gradually increasing activity, judicious use of pharmacological agents and perhaps medical marijuana, if available to you, are particularly effective.

Pharmacological agents include those you mentioned and additional medications all well known to neurologists and pain specialists. While you search with your neurologist or pain specialist for a medication that helps take the edge off the pain, also start looking into the other therapies I mentioned. There are even mindfulness training classes on line.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

Mascha Brautigam

2/9/2018 05:03:57 am

Thank you. I have tried many mindfulness and have no benefit. I do stay active and noticed if I'm less active i get stiff. My doctor recommended i stay on Amitriptyline but a low dosage. Start with 40mg drop to 35 mg to eventually 25 mg. I'm not sure why i need to increase my dosage and then drop.
Does 25 mg cause weight gain(fluid retention)???
I'm not keen to go back to 40 mg for 1 week ,35 mg,30 mg to 25 mg.
I was the last 2 dsys on 15 mg and why not just go to 25 mg? Doesn't make sense.
Can Amitriptyline cause MS like symptoms as side effect??

Lynn

2/10/2018 05:25:57 am

I have awful side effects to all the traditional pain meds, but have had relief with low dose naltrexone. It is not yet condoned by the MS medical community at large (but there are isolated practitioners prescribing it now), and is not a cure all It is slow to start working, tricky to figure out the right dose, and won't necessarily work. BUT if you find the right dose and commit, it is an inexpensive, excellent older med for several MS symptoms including nerve pain, mood and incontinence.

The main adverse affects are trouble sleeping (although some get better sleep, and most adjust), and although it helps spasticity up to a point, if you take too much it makes it much worse.

I gained over 50 pounds on Lyrica, neurontin, and amitriptyline (and a temporary Type 2 diabetes dx with the amitriptyline). I also had palinopsia as an adverse effect with the latter as well as bladder retention. Won't even get started on the first two meds.

Dr Revere Kinkel

2/12/2018 04:25:37 pm

Low dose Naltrexone is a reasonable option for various types of MS related pain. Bruce Cree at UCSF did a controlled study of 4.5 mg at bedtime several years ago, and reported improvement in several quality of life scores include improvement in the effect of pain on quality of life. Some people experience vivid dreams, but most tolerate it well.

It is not an approved medication in this dose, so you will need to take a prescription from your doctor to a compounding pharmacy and pay for it with cash. It may help to shop around for a compounding pharmacy with the best price. Most people take between 3 mg and 4.5 mg at bedtime only.

Be sure to continue your physical activity and perhaps another form of meditation will be more effective than your experience with Mindfulness. Again there is never a simple solution to chronic problems like pain.

Good luck

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