Treatment for Persistant Nerve Pain

Content provided by the Faculty of the Harvard Medical School

Treatment for Persistant Nerve Pain

Question:

I have been struggling with a persistent pain on the right side of my belly. More recently, it feels like it originates in my back and wraps around to the front. My doctor ordered a bunch of blood tests and a CAT scan of my abdomen. Everything appears to be normal. My doctor is quite sure that this is a pinched nerve. Can you get this much pain from a pinched nerve? And the medications my doctor prescribed to treat the pain are so expensive. Any suggestions?

Answer:

What you describe is actually quite common. It sounds like your pain is coming from one of the nerves leaving the spine. These spinal nerves wrap around from the center of your back to the sides of your body. Doctors call this type of nerve pain radiculopathy, or spinal nerve root pain.

Indeed, the pain can be very severe. Also nerve pain often has a very irritating quality that can be more uncomfortable than pain due to other causes.

Treating persistent nerve pain can be frustrating. There is no best approach. Finding the right therapies and medications to control persistent pain is a process of trial and error. The goal is to find the most effective combination with the least amount of side effects, while trying to keep costs reasonable.

When cost is an issue, I usually suggest a combination of a generic nonsteroidal antiinflammatory drug (NSAID) and one of the tricyclic antidepressants. If you cannot take NSAIDs because of an allergy, kidney problems, gastritis, or peptic ulcer disease, generic acetaminophen can also be combined with a tricyclic.

Of the NSAIDs, naproxen tends to be my first choice for chronic pain because you only need to take it twice per day. Ibuprofen is just as effective. And if one doesn't work, try the other.

When I prescribe a tricyclic antidepressant for pain, patients often respond, "But I am not depressed." Today, tricyclics are used more for treatment of chronic pain, especially persistent nerve pain. Examples include amitriptyline, nortriptyline, desipramine, and doxepin.

I recommend starting with a very low dose, such as 10 milligrams of amitriptyline at night. These drugs can be very sedating; increase the dose gradually. Unlike NSAIDs and acetaminophen, you won't get the pain relief right away from the tricyclic. It may take a few weeks to work.

There are many other options, including topical medications applied to the skin and non-pharmacologic therapies. Keep working with your doctor, and let him or her know that cost is an important issue for you.

Last updated:	March 03, 2009