Treatment

Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms. If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves.

Medications

Besides medications used to treat conditions associated with peripheral neuropathy, medications used to relieve peripheral neuropathy signs and symptoms include:

• Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers.

  Medications containing opioids, such as tramadol (Conzip, Ultram, others) or oxycodone (Oxycontin, Roxicodone, others), can lead to dependence and addiction, so these drugs generally are not prescribed unless all other treatments fail.

• Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness.

• Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it.

  Lidocaine patches are another treatment you apply to your skin that might offer pain relief. Side effects can include drowsiness, dizziness and numbness at the site of the patch.

• Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin (Silenor, Zonalon) and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.

  The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta, Drizalma Sprinkle) and the extended-release antidepressants venlafaxine (Effexor XR) abd desvenlafaxine (Pristiq) also might ease the pain of peripheral neuropathy caused by diabetes.

  Side effects of antidepressants may include dry mouth, nausea, drowsiness, dizziness, changes in appetite, weight gain and constipation.

Therapies

Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy.

• Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month.

• Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions.

  Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins).

• Physical therapy. If you have muscle weakness, physical therapy can help improve your movements. You may also need hand or foot braces, a cane, a walker, or a wheelchair.
• Surgery. If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you might need surgery to reduce the pressure.