Medication Summary
Painful dysesthesias associated with alcoholic neuropathy can be treated using gabapentin or amitriptyline as adjunct agents with other OTC pain medications, such as aspirin or acetaminophen.
Anticonvulsants
Class Summary
Use of certain antiepileptic drugs, such as the gamma aminobutyric acid (GABA) analogue gabapentin (Neurontin), has proven helpful in some cases of neuropathic pain. These drugs have central and peripheral anticholinergic effects, as well as sedative effects, and they block the active reuptake of norepinephrine and serotonin. The multifactorial mechanism of analgesia could include improved sleep, an altered perception of pain, and an increase in the pain threshold. Rarely should these drugs be used in the treatment of acute pain, because a few weeks may be required for them to become effective.
Gabapentin (Neurontin)
Gabapentin has anticonvulsant properties and antineuralgic effects; however, the exact mechanism of action is unknown. Gabapentin is structurally related to GABA but does not interact with GABA receptors.
Tricyclic antidepressants
Class Summary
These agents make up a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. They have central effects on pain transmission and block the active reuptake of norepinephrine and serotonin.
Amitriptyline (Elavil)
Amitriptyline is an analgesic for certain chronic and neuropathic pain.
Analgesic, Topical
Class Summary
When used topically, capsaicin works through the depletion of substance P. It causes significant burning sensations when applied, and patients must be educated about this effect.
Capsaicin topical (Dolorac, Zostrix)
Capsaicin is a natural chemical derived from plants of the Solanaceae family. It penetrates deep for temporary relief of minor aches and pains of muscles and joints associated inflammatory reactions. It may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons.
