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Prescription Drugs for Diabetes Nerve Pain continued...

Of the TCAs, Elavil has been a very good option for pain, yet it has troublesome side effects, including drowsiness, weight gain, dry mouth, and dry eyes. For people with peripheral neuropathy, there can be additional side effects. Many people also develop blood pressure and heart rate problems and get dizziness when taking Elavil.

A newer drug in this class, Pamelor, is  effective and has fewer side effects, so it is better tolerated. Norpramin is also considered good and has the least side effects of all.

  • Selective serotonin reuptake inhibitors (SSRIs) are a newer form of antidepressant. These drugs work by altering the amount of the brain chemical serotonin. SSRIs are very effective for depression, the experts say, but less effective for pain. Some studies have shown them to be beneficial, but they're still less effective than TCAs for pain.

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.

    Effexor and Cymbalta are quite effective for pain and have fewer side effects than the SSRIs or TCAs. Cymbalta is FDA-approved for painful neuropathy; Effexor is not.

Antiseizure drugs. Drugs that prevent epileptic seizures can also relieve certain pain conditions, including neuropathy. The drugs work by controlling the abnormal firing of nerve cells in the brain and other parts of the body, such as legs and arms.

  • Neurontin is the antiseizure drug most commonly used for nerve pain from peripheral neuropathy.  While it's effective at treating painful neuropathy, it tend to cause sedation or dizziness at higher doses. But if the dosage is increased slowly, it is well tolerated.
  • Lyrica is a seizure medication that is FDA-approved for painful neuropathy. The most common side effects are dizziness and sleepiness. 

Opioid medicines. When pain is very severe, people want immediate relief. That's when you may need to see a pain specialist. Sometimes people need strong painkillers called Ultram or Ultracet, possibly in combination with Neurontin. The combination gets people past that acute stage of pain.

Both Ultram and Ultracet are FDA-approved painkillers that contain tramadol, a weak opioid (morphine-like) substance. The drug also weakly affects the brain chemicals serotonin and norepinephrine, similar to antidepressants, which reduces the perception of pain.

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