Treating the underlying cause
There are many different causes of peripheral neuropathy, some of which can be treated in different ways.
- diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting down on alcohol, maintaining a healthy weight and exercising regularly
- vitamin B12 deficiency can be treated with B12 injections or tablets
- peripheral neuropathy caused by a medicine you're taking may improve if the medicine is stopped
Some less common types of peripheral neuropathy may be treated with medicines, such as:
- steroids – powerful anti-inflammatory medicines
- immunosuppressants – medicines that reduce the activity of the immune system
- injections of immunoglobulin – a mixture of blood proteins called antibodies made by the immune system
But the underlying cause may not always be treatable.
Relieving nerve pain
You may also require medicine to treat any nerve pain (neuropathic pain) you're experiencing.
These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect.
Higher doses may be better at managing the pain, but are also more likely to cause side effects.
The most common side effects are tiredness, dizziness or feeling "drunk". If you get these, it may be necessary to reduce your dose.
Do not drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.
The side effects should improve after a week or two as your body gets used to the medicine.
But if your side effects continue, tell your GP as it may be possible to change to a different medicine that suits you better.
Even if the first medicine tried does not help, others may.
Many of these medicines may also be used for treating other health conditions, such as depression, epilepsy, anxiety or headaches.
If you're given an antidepressant, this may treat pain even if you're not depressed. This does not mean your doctor suspects you're depressed.
The main medicines recommended for neuropathic pain include:
- amitriptyline – also used for treatment of headaches and depression
- duloxetine – also used for treatment of bladder problems and depression
- pregabalin and gabapentin – also used to treat epilepsy, headaches or anxiety
There are also some additional medicines that you can take to relieve pain in a specific area of your body or to relieve particularly severe pain for short periods.
If your pain is confined to a particular area of your body, you may benefit from using capsaicin cream.
Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain.
Rub a pea-sized amount of capsaicin cream on the painful area of skin 3 or 4 times a day.
Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area at the start of treatment.
Do not use capsaicin cream on broken or inflamed skin, and always wash your hands after applying it.
Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that does not respond to other treatments your GP can prescribe.
Like all opioids, tramadol can be addictive if it's taken for a long time. It'll usually only be prescribed for a short time.
Tramadol can be useful to take at times when your pain is worse.
Common side effects of tramadol include:
- feeling sick or vomiting
Treating other symptoms
In addition to treating pain, you may also require treatment to help you manage other symptoms.
For example, if you have muscle weakness, you may need physiotherapy to learn exercises to improve your muscle strength.
You may also need to wear splints to support weak ankles or use walking aids to help you get around.
Other problems associated with peripheral neuropathy may be treatable with medicines.
In some cases, you may need more invasive treatment, such as:
Alternative and complementary therapies
As peripheral neuropathy can be a very painful and troublesome problem that may only partly be relieved by standard treatments, you may be tempted to try other therapies.
These may include:
- herbal medicine
- benfotiamine (a form of vitamin B1) supplements
- alpha-lipoic acid (an antioxidant) supplements
But while some people may find these helpful, the evidence for them is not always clear.
Speak to your doctor before trying these treatments in case they could interfere with your ongoing treatment.