Neuropathic pain treatments: Medicines other than conventional drugs

Editor’s Note: Dr Mailis-Gagnon will be writing for CARP Action Online on a semi-regular basis. Should you have any questions about pain please write to us at [email protected] We will try to integrate some of your concerns in Dr. Mailis- Gagnon’s future columns.

In the previous paper I discussed two classes of drugs that your doctor can prescribe for neuropathic pain: “Neuropathic adjuvant” drugs specifically for injured nervous tissues, and painkillers. This time I will discuss a lot of other “medicinal” treatments beyond this traditional pharmacotherapy. Alternative medicines (herbal medicines, homeopathic treatments etc), in my experience to this date, have not been effective for serious neuropathic pain. In general, I have no problems if my patients ask me about trying herbal medicines or all forms of alternative treatments. They are worth a try, but tell your doctor “what else” you are taking, as some herbal/natural treatments may be contraindicated in some conditions or may interact with conventional prescription drugs.

Another type of medical treatments is application of local remedies that can only be bought with a doctor’s prescription, such as the “lidoderm patch” that contains a local anesthetic and helps patients with localized areas of hypersensitivity, as in post herpetic neuralgia. Unfortunately, this is only available in the US. Another older local product contains capsaicin, the essential ingredient of red hot chilli peppers, and comes in the form of cream. It is available in Canada and may help some patients with diabetic neuropathy. Unfortunately, many patients will stop the application as they can not tolerate the initial “wave of burning pain” before the painful area gets numb. There is some local preparation, also, that can be bought over the counter, advertised as effective in neuropathic pain, particularly diabetic neuropathy. Again, I have never been impressed by any dramatic benefit in serious neuropathic pain.

Personally, I ask a “compounding pharmacy” to create local mixtures of active medications (for example some of those I discussed in the previous article) diluted in a liquid that makes local absorption easier. The compounding pharmacies are specialized pharmacies that create medicines by mixing them based on special prescriptions. These compounds need a doctor’s prescription and are not usually covered by government insurance. Again, as with every form of local treatment I discussed, few patients only with localized areas of skin supersensitivity may experience some benefit (in my experience, the “neuropathic” prescription medications I discussed in the previous paper, are more successful than any local remedies).

One special mention must be made for a specific treatment in patients with Multiple Sclerosis (MS), a degenerative condition of the nervous system, which results in spasms, stiffness, weakness, lack of coordination and very often pain. Marijuana has been found to have some good effects in such patients. Canada was the first country in the world a few years ago to approve a formal medicine derived from marijuana, a spray that one can spray in the inside of the mouth a few times a day. This spray is also prescribed by physicians for other kinds of serious neuropathic pain. It is a real drug and the patient has to follow the doctor’s specific instructions. Unfortunately, it is quite expensive and is covered only by extended health care plans to the best of my knowledge.