No drug has been approved to repair or 'cure' nerve damage although peripheral nerves have the ability to regenerate, as long as the
nerve cell itself is not dead. Symptoms can often be controlled and eliminating the specific causes of forms of neuropathy can prevent
new damage.
The type of neuropathy treatment that will work best for an individual will vary widely depending on the cause of the
pain and whether or not the patient suffers from other conditions.
In principle, any other underlying conditions are treated first,
followed by symptomatic treatment for neuropathy.
For HIV patients the first step is to establish whether any drugs in your combination
therapy are known neuropathy causes - if so and if it's safe to do so, then stopping those drugs, or substituting them for a better
alternative is the first line of treatment.
Medication
Don't be alarmed by the number of brand names and pharmaceutical descriptions of drugs which follow. It seems a complex
list but the likelihood is that you will come across one or more of these drugs during your treatment. Hopefully, you'll only need
the one which is a success but actually there aren't that many options open to doctors and neuropathy is one of those diseases which
tends to confound the norms. What works for one may not work for another...you know the story.
Pain killers 
We live in a culture where drugs are both available and freely given but as an HIV patient you will
already understand the general rule; the fewer the better. However neuropathy is a remorseless disease for some people and drugs are
necessary to control the pain.
Mild symptoms may be relieved by over-the-counter pain medications like paracetemol, ibuprofen and
aspirin but watch out for stomach problems. If the symptoms are more severe, your doctor may recommend prescription painkillers. Drugs
containing opiates, such as codeine, can lead to dependence, constipation or sedation, so these drugs are generally prescribed only
when other treatments fail however many people end up on drugs from the morphine family because nothing else will help.
However, as you know, prescription drugs only relive the pain for a limited time and do nothing to improve the condition itself. They
may provide some level of temporary relief but as the disease progresses, the dosage of the drug needed to continue suppressing the
pain effectively may need to increase concurrently possibly leading to addiction. The side effects of these types of drugs can
also be difficult to deal with and even increase your problems. When the increased drug dosage reaches a threshold level, the patient
can become exposed to symptoms that seem far worse than the original illness. Symptoms similar to Alzheimer’s can follow. Many people
see that as an acceptable risk so long as the quality of life is improved through less pain.
Good relationships with your health care
professionals are clearly important but although they're the experts, don't let them bully you - it's your body. Try to resist
moving on to the more powerful drugs for as long as you can and always talk over the possibility of stopping them with your doctor.
Withdrawal symptoms can be very unpleasant so everything needs to be thought through but it has been known for neuropathy patients
to stop the morphine type drugs because they have helped and in some cases have reversed the pain. It helps your decision making,
if you are aware of the possible side effects of your drugs but most HIV patients are used to doing their own research when it comes
to their treatment.
Remember, every drug you take may have an effect on your HIV medication - always check with the doctor.
Because analgesics
(e.g., aspirin, ibuprofen) are usually ineffective against pain caused by neuropathy, treatment often involves medications that target
nerve cells. However, Paracetemol (up to 6 x 500mg per day) is often recommended as a starter and may help with pain due to muscular
tension and is also kinder to your stomach.
Other drugs
Simply put, most of the following drugs are intended to interrupt, confuse or suppress the electrical and chemical activity
of the nerves and the pain impulses to the brain, thus reducing the symptoms of neuropathy.
Antidepressants.
Tricyclic antidepressant
medications, such as amitriptyline
and nortriptyline (Pamelor), were originally developed to treat depression. However, they have
been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.
The serotonin and norepinephrine reuptake inhibitor duloxetine
(Cymbalta) also has proved effective for peripheral neuropathy caused
by diabetes. Side effects may include nausea, drowsiness, dizziness, decreased appetite and constipation.
Anti-seizure medications.
Drugs such as gabapentin (Neurontin)
, topiramate (Topamax), pregabalin (Lyrica)
, carbamazepine (Tegretol) and phenytoin (Dilantin)
were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects of these drugs
include drowsiness, dizziness, low blood pressure, and fatigue.
Carbamazapine often results in over-sensitivity, or liver problems
or interactions with HIV medication. The other drugs mentioned (Pregabalin, gabapentin) don't carry this risk.
Pregabalin (Lyrica®)
has been approved by the Food and Drug Administration (FDA) to treat post-herpetic neuralgia (shingles pain). Common side effects
include drowsiness, dizziness, nausea, weight gain, and swelling (oedema).
Other medications include the anticonvulsants (e.g.,
Carbamazepine
[Tegretol®], Lamotrigine [Lamictal®]), local anaesthetics (e.g., Lidocaine [Xylocaine®]), and antiarrhythmics (e.g., Mexiletine [Mexitil®]).
Anticonvulsants may cause low white blood cell counts, nausea, vomiting, and dizziness. Side effects of lidocaine and mexiletine include
nervousness, light-headedness, drowsiness, and double vision.
Lidocaine patches.
This patch contains the topical anaesthetic lidocaine.
You apply it to the area where your pain is most severe, and you can use up to four patches a day to relieve pain. This treatment
has almost no side effects except, for some people, a rash at the site of the patch.
Topical treatment with
Capsaicin cream (Zostrix)
may be prescribed for neuropathy patients. Capsaicin (red hot chilli peppers!)
causes stinging upon application and is often combined
with a local anaesthetic to reduce this side effect.
Axsain (.25% capsaicin in Lidocarevehicle) contains a higher dose of capsaicin
in a cream that reduces stinging and burning.
Lidoderm(lidocaine patch 5%) has been shown to be helpful for localized areas of tingling
or burning but is not available or approved in all countries.
Injection Therapy
Injection therapy involves injecting a nerve block (e.g., lidocaine) into the area surrounding affected nerves,
preventing the nerve from carrying impulses to the brain and temporarily reducing symptoms. Injection therapy is often used with other
treatments (e.g., medication, physical therapy).
Combination Therapy
Combination therapy regarding neuropathy has not been widely
researched but there are sufficient cases to warrant a paper being published in The Lancet. Normal medication research compares the
performance of one medicine against a placebo but with problems such as high blood pressure, asthma, HIV and cancer, the effectiveness
of combining drugs te achieve an successful treatment are widely known.
With a condition such as neuropathy where the success
of mono-therapy is limited to say the least, it seems logical that research into combination therapies could be widened. Thus far,
studies have been made into combining gabapentine with nortriptyline, morphine and oxycodon. The results seem promising but this site
does not have sufficient information to form an opinion. It should at least be enough to start a conversation with your doctor or
specialist to explore the possibilities.
