We welcome your questions. Neuropathic pain is a common condition. Peripheral neuropathy is a result of damage to peripheral nerves from traumatic injuries, infections, metabolic problems, inherited causes or exposure to toxins. One of the most common causes is diabetes mellitus. It often causes weakness, numbness and pain, usually in the hands and feet but it can also affect other areas of your body. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling.
Another problem that can progress to chronic neuropathic pain is postherpetic neuralgia (PHN), a complication of shingles. Shingles (medically known as herpes zoster) result from the reactivation of the varicella-zoster virus that is most commonly contracted during childhood in the form of chickenpox. Virus that had remained dormant for decades can re-manifest as a painful, blistering, and vesicular rash. While the characteristic rash of herpes zoster usually clears within 2 to 4 weeks, 20% of people may experience pain in the form of PHN that persists after the rash has healed. The pain is a consequence of peripheral nerve damage caused by the herpes zoster attack, and can persist for years. Risk factors for PHN include advanced age, female gender, chronic disease, immunocompromised condition, and a greater severity of outbreak and pain during the acute phase.
The management of chronic neuropathic pain is challenging and as many as half of patients fail to respond to any conventional (commercially available) treatment. Other patients may experience limited benefits even when taking multiple medications. Health care providers have increasing interest in the optimization and personalization of therapy based upon the underlying cause of neuropathic pain and the patient’s symptoms.
Treatment options to date have mainly been centered on oral therapies, including tricyclic antidepressants, opioid analgesics, and corticosteroids. Therapeutic doses of these oral medications often carry a high risk of side effects and even opioid addiction.
Oral gabapentin is a common treatment for neuropathic pain, although doses that are adequate to provide pain relief usually produce intolerable drowsiness or dizziness. Small studies and case reports have found that topical application of compounded gabapentin gel relieved neuropathic pain without unwanted systemic side effects.
Some people with peripheral neuropathy have benefitted from these complementary therapies:
- Alpha-lipoic acid – be cautious and talk to your doctor because alpha-lipoic acid can affect blood sugar levels (and diabetes is often the cause of peripheral neuropathy).
- Herbs such as evening primrose oil might help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so don’t start herbal therapies before discussing with our pharmacist and your doctor.
- Amino acids such as acetyl-L-carnitine might benefit people who have diabetes or who have neuropathic pain following chemotherapy.
Our pharmacist can recommend the product and dose that will be best for you.
Ask our pharmacist how compounded medications and professional quality supplements might help neuropathic pain.