Harvard Men's Health Watch

Drugs that relieve nerve pain

When chronic pain comes from the nerves, these medications can help when added to other pain relievers.

For chronic muscle and joint pain, the most effective therapies are rest, ice and heat, anti-inflammatory medications, and time. Usually, the pain calms down and you feel better.

In some cases, however, at least part of the pain may come from the nerves as well as the injured and inflamed muscle or joint. Typical signs of this "neuropathic" pain include sharp, stinging pain or pain that radiates from one part of the body to adjacent areas. One of the most common causes is diabetes, although it can also be brought on by injury, infection, and some medications.

"People say things like, 'My knee hurts and I feel like it's coming up to the middle of my thigh and down to my shin," says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. "In those cases, the nerve may be involved."

In neuropathic pain, the nerve that was the mere messenger of pain now becomes an additional source. It's not safe to continually increase doses of narcotic pain relievers, but fortunately there are other options. Certain drugs that were originally developed to treat depression and seizure disorders also damp down inappropriate or excessive pain signaling in the nerves.

Drugs that help

A variety of drugs can be added to conventional pain relievers to reduce nerve pain. Adding one of these drugs won't completely take the pain away, but it may help.

Anticonvulsants: These medications were developed to control seizures, but they also help to blunt pain signals in the nerves. Several are in wide use for chronic pain. The most commonly used one is gabapentin (Neurontin), but there are others (see "Medications for nerve pain").

It takes four to six weeks for the full effect to kick in. Your doctor will start you on a low dose and gradually increase it. That reduces side effects.

Antidepressants: Certain types of antidepressants also help to control nerve pain. They may have a synergistic effect in people who experience depression along with chronic pain: Chronic pain often causes depression, and depression can intensify a person's sensitivity to pain; some antidepressants address both. There are three options:

  • Tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor). These drugs have the strongest evidence backing them.

  • Serotonin–norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor). These drugs are prescribed for pain at doses lower than are effective for depression. SNRIs have fewer side effects than tricyclics, although some research suggests they may be less effective.

  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), are the most commonly prescribed medications for depression. Some doctors may try these for treating nerve pain, too, but the evidence backing them is mixed.

Types of pain: Nociceptive vs. neuropathic

  • Nociceptive (body) pain comes from damaged tissues outside the nervous system, such as muscles and joints. People say the pain feels aching and throbbing.

  • Neuropathic (nerve) pain comes from the nerves that transmit pain signals from the body to the brain. People describe the pain as burning, stinging, or shooting. It may radiate from one area of the body to another. It may be accompanied by numbness and tingling.

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Doctors usually try one type or the other (antidepressants or anticonvulsants), although they can be combined. They are taken daily in addition to conventional pain relievers.

Medications for nerve pain





• amitriptyline (Elavil)

• doxepin (Sinequan)

• nortriptyline (Pamelor)


• duloxetine (Cymbalta)

• milnacipran (Savella)

• venlafaxine (Effexor)

• carbamazepine (Tegretol)

• gabapentin (Neurontin)

• lamotrigine (Lamictal)

• pregabalin (Lyrica)


Dry mouth, sexual

dysfunction, dizziness,

constipation, blurred

vision, and upset stomach.

Nausea, dizziness,

sweating. Tend to have

fewer side effects than

tricyclic antidepressants.

Drowsiness, dizziness, and

nausea. Avoid alcohol when

taking these drugs.