Millions of people live with nerve pain that never seems to go away. This kind of pain can feel like burning, tingling, stabbing, or electric shocks in the body.
It often affects the feet, legs, hands, or arms and can make everyday life very difficult. Even simple activities such as walking, sleeping, or holding objects can become painful.
This type of pain is known as neuropathic pain. It happens when nerves are damaged or stop working properly. Normally, nerves send signals between the brain and the rest of the body.
These signals allow us to feel touch, temperature, and pain. But when nerves are injured or malfunctioning, they can send the wrong signals to the brain, which causes long-lasting pain.
In the United States alone, more than 20 million people live with neuropathic pain. Doctors can often identify the reason for the nerve damage. For example, diabetes, infections, injuries, chemotherapy, or certain autoimmune diseases can damage nerves.
However, in many cases doctors cannot find the cause of the nerve problem. About one quarter of patients with neuropathic pain fall into this category. Their condition is called cryptogenic sensory polyneuropathy, often shortened to CSPN.
The word “cryptogenic” simply means that the cause is unknown. Because the cause cannot be identified, this condition can be very frustrating for both patients and doctors.
When doctors know the cause of nerve pain, they can sometimes treat the underlying problem. But when the cause is unknown, treatment usually focuses only on reducing the pain. Unfortunately, there is very little clear guidance about which medications work best for CSPN.
As a result, many patients must try several different drugs before they find one that helps. Some people may never find a treatment that works well for them.
To improve this situation, researchers from the University of Missouri carried out a large clinical study. Their goal was to compare several medications that doctors already use to treat nerve pain and see which ones work best for people with CSPN.
The research team studied four different drugs: nortriptyline, duloxetine, pregabalin, and mexiletine. Although all of these medicines can be used for nerve pain, they were originally developed for different medical purposes.
Nortriptyline is an older antidepressant medication. Doctors have used it for many years, and it is sometimes prescribed for chronic nerve pain. Duloxetine is a newer type of antidepressant called an SNRI. It works by affecting certain chemical signals in the brain that influence mood and pain perception.
Pregabalin is a medication often used to treat seizures, but it is also widely prescribed for nerve pain. Mexiletine is usually used to treat irregular heart rhythms, although doctors sometimes use it to help reduce nerve pain.
The study included 402 adults who were at least 30 years old. All of the participants were living with significant nerve pain. On a pain scale from 0 to 10, every participant rated their pain as at least a 4, which means their symptoms were moderate to severe.
Each person in the study was randomly assigned to take one of the four medications. They continued taking the medication for 12 weeks while researchers monitored their progress.
During the study, the scientists looked at two main things. First, they measured whether the medication reduced the patient’s pain. Second, they observed whether patients continued taking the medication or stopped using it because of side effects or because it did not help.
When the 12-week study period ended, the results showed clear differences between the medications.
Nortriptyline turned out to be the most effective overall. About 25 percent of the people who took nortriptyline experienced meaningful relief from their nerve pain. In addition, fewer people stopped taking the drug compared with some of the other medications.
Duloxetine produced similar results. Around 23 percent of patients reported improvement in their pain, and the number of people who stopped taking the medication was also relatively low.
Pregabalin was less successful in this study. Only about 15 percent of the patients taking pregabalin reported significant pain relief.
Mexiletine had the highest number of patients who stopped treatment. More than half of the participants taking this drug—about 58 percent—stopped using it during the study. This may have been due to side effects or because the medication did not provide enough benefit.
Although none of the medications helped everyone, the results suggest that nortriptyline and duloxetine may be the most promising starting treatments for people with CSPN. These drugs appeared to offer the best balance between pain relief and tolerable side effects.
The researchers say more studies are still needed. Other medications, such as gabapentin, venlafaxine, and certain sodium channel blockers, are also used for nerve pain. Future research may help determine whether these drugs could also benefit patients with unexplained nerve damage.
The study was led by Dr. Richard Barohn and his team and was published in the medical journal JAMA Neurology.
This research represents an important step toward improving treatment for people living with chronic nerve pain. With better scientific evidence, doctors may be able to choose effective treatments more quickly, helping patients find relief sooner.
If you care about pain, please read studies about how to manage your back pain, and Krill oil could improve muscle health in older people.
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