Pharmacotherapy for nerve pain
| Therapy | Drug class | Drugs | Mechanism of action | Adverse effects |
|---|---|---|---|---|
| First-line therapy | Calcium channel blockers | Gabapentin | It inhibits α2δ subunit of VGCCs. | Peripheral swelling |
| Pregabalin | It inhibits α2δ subunit of VGCCs. | Peripheral swelling and increased bodyweight | ||
| TCAs | Amitriptyline | It inhibits the reuptake of serotonin and norepinephrine. | Arrhythmia and suicide risk | |
| SNRI | Duloxetine, venlafaxine | These act by inhibiting the reuptake of serotonin and norepinephrine. | Ataxia, hyperhidrosis and hypertension | |
| Second-line therapy | Opioids | Tramadol | It acts by binding to opioid receptors. | Seizures and ataxia |
| Tapentadol | It inhibits the reuptake of serotonin and norepinephrine. | Seizures and ataxia | ||
| Topical treatments | Lidocaine | It acts by binding to sodium channels. | Local erythema, itching and pain | |
| Capsaicin | It interacts chemically with sensory neurons for its action. | Pain and itching | ||
| Third-line therapy | Strong opioids | Morphine | It acts by binding to opioid receptors. | Dizziness and lethargy |
| Neurotoxins | Botulinum toxin | It acts by decreasing the release of acetylcholine. | Pain at injection site |
SNRI: serotonin-norepinephrine reuptake inhibitors; TCAs: tricyclic antidepressants; VGCCs: voltage-gated calcium channels