This is just a huge subject. There are primarily two ways PN may be "treated".
1) Most of the people with PN can only be helped palliatively. This means by reducing symptoms of pain, burning and numbness.
2) The second way is by using agents to modify the disease process. IVIG and Rituxan are examples of this. Also if the PN is secondary to autoimmune issues, reducing autoimmune antibodies may modify the disease process in some patients.
Those agents are classed as autoimmune drugs, which suppress antibody production in the body.
3) Patients with hereditary PN, do not have treatments yet other than symptom reduction types.
This is an old list of treatments I made years ago. It does not include supplements, because we have a separate thread now on this forum for that: statements in
red are added today by me.
Quote:
Drugs for PN...
AEDs (anti-seizure drugs)
Tegretol/Trileptal both drugs are cousins and similar in action
Dilantin (phenytoin)
Topamax --hard to tolerate
Zonegran
Lamictal
Neurontin/Lyrica
Keppra
Gabatril
Prescription Vitamin preparations
Mentax (the newest and best--- methylfolate, P5P, and methylcobalamin)
Folgard RX--
also Deplin which is high dose methylfolate
Antidepressants-- a partial listing
Elavil (amitriptyline)-- a tricyclic
Pamelor (nortriptyline)-- a tricyclic
Prozac, Lexapro, Celexa, Zoloft, Paxil --- SSRIs
Effexor, Cymbalta -- some norepinephrine reuptake actions
Desyrel (trazadone) mostly for sleep issues
Opiates--this is a partial list
Oxycodone (Oxycontin,Percocet)
Morphine (Avinza, MsContin, Kadian)
Duragesic patches (fentanyl)
Vicodin, Lortab Norco (hydrocodone with tylenol)
Codeine (Tylenol with Codeine)
Methadone
Dilaudid (hydromorphone)
BuTran patches -- buprenorphine
NonOpiates for pain relief
Darvon/Darvocet --FDA removed this from sale in US.
Talwin/Talacen
NSAIDs (Ibuprofen, naproxen, Celebrex, Indocin)
Tylenol
Ultram (tramadol)
AlkaSeltzer (with aspirin)
Anti-diabetic drugs for diabetes type I, insulin resistance, and type II diabetes--
There are many more new drugs used for type II now, and also basal insulins injected are now used. I won't list them all here.
examples
Metformin (Glucophage)
Actos
Avandia
Glypizide
Glyburide
Prandin
Benzodiazepines (AntiAnxiety/muscle relaxant)
Klonopin (clonazepam)
Xanax (alprazolam)
Ativan (lorazepam)
Valium (diazepam) Valium and Klonopin are the most commonly used for muscle issues/ and also have some anti-seizure effects
Topical agents
Lidoderm patches-- these are very nice if placed properly
Lidocaine ointment
Emla cream (now called LMX 5%)-- some numbing agents are OTC as well.
compounded ointments with Ketamine/clonidine/ketoprofen/gabapentin etc
Biofreeze (OTC)(this is very cooling, and also anti-inflammatory)--there is a new product by BenGay without the ilex called Cold Therapy with 5% menthol
These work because they contain menthol, which stimulates cold receptors and blocks burning sensations from nerves.
Capsacin cream (most people cannot tolerate the burning from this, but others like it)
The new RX patch Qutenza is capsasin in 8% concentration and requires medical supervision for application
Muscle relaxants (non benzo)
Flexeril (cyclobenzaprine)-- most commonly tried--Amrix is a new delayed release of this
Soma (carisoprol)-- abusable--but some people find it useful
Robaxin -- old timer not used much anymore
Norflex (orphenadrine)
Skelaxin-- very sedating, and often used for resistant patients who don't respond well
Baclofen (Lioresal)--mostly for spasticity issues
Dopamine agonists (for restless legs/movement disorder)
Mirapex
Sinemet
Requip
Misc:
Stadol nasal-- very abusable no longer available
levothyroxine--T4 (for thyroid replacement-- if low), liothyronine (T3)
antihistamines for skin burning (Benadryl/Claritin/Zyrtec/Atarax/Allegra)Allegra, Zyrtec, Benadryl and Claritin are OTC now.
Singulair (leukotriene B4 antagonist for allergic issues)
Also some people are receiving infusions of Lidocaine which may be helpful, and also ketamine...but the RSD patients usually use the ketamine today.
And immune suppressing or disease modifying drugs:
IVIG
Rituxan
Imuran
Cellcept
Prednisone/methylprednisolone
methotrexate
Lefunomide -- this agent is fairly toxic and there are studies showing it actually causes PN... use with caution and care.
and others may be tried in autoimmune cases.
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This thread will deal with the treatments by group and the next thread will start with the AED... anti-seizure drugs. These can block signals being passed on by nerves from reaching the brain.
I found some technical explanations for some of the drugs, which may be helpful in the post for those taking them.
edit: quick link to amitriptyline and nerve growth factors:
http://neurotalk.psychcentral.com/sh...=amitriptyline
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All truths are easy to understand once they are discovered; the point is to discover them.-- Galileo Galilei
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Weezie looking at petunias 8.25.2017
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