Pain, such as from stubbing your toe, has a physical cause. However, pain can also be generated by your body's nerves without a physical source. This type of pain is called neuropathic pain, and appears to have no cause, making treatment difficult. For some people neuropathic pain is unresponsive to traditional forms of therapy and may lead to serious disability.

Chronic Neuropathic Pain

Neuropathic pain is associated with abnormal functioning of the nervous system. The nerves that affect the perception of pain behave in abnormal ways in patients with neuropathic pain. Neuropathic pain often seems to have no cause. For example, you may feel pain in a limb that has been amputated (phantom limb pain). Stimuli that cause little or no pain in healthy people can cause very intense, long lasting neuropathic pain, which is very difficult to treat. Many painkillers, including some very powerful drugs such as morphine, have little effect on neuropathic pain. For this reason, there is a great deal of interest by researchers in using drugs not approved as painkillers to treat neuropathic pain.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drugs Breakthrough Options: Amitriptyline, Clomipramine, Desipramine, Nortriptyline, Bupropion, Carbamazepine, Gabapentin, Lamotrigine, Lidocaine, Mexiletine, Oxcarbazepine, Phenytoin, Rituximab, Tiagabine, Venlafaxine

Post-herpetic Neuralgia

Post-herpetic neuralgia is triggered by the virus that causes chickenpox. A small amount of this virus can remain in the body for many years after the initial chickenpox illness. When the virus is reactivated by stress, age, or other unknown factors, it travels along nerve cells and causes pain. When the virus reaches the skin, it produces a rash and blisters. This condition is known as shingles or herpes zoster. You may continue to feel pain long after the rash and blisters disappear, which is called post-herpetic neuralgia.

Commonly Prescribed (On-Label) Drugs: Lidocaine

Off-Label Prescription Drugs Breakthrough Options: Amitriptyline, Nortriptyline, Carbidopa-levodopa, Clonidine, Desipramine

Trigeminal Neuralgia

Trigeminal neuralgia is an extremely painful condition that usually affects people over age 50, most often women. In involves the fifth cranial nerve, which leads to the head. The trigeminal nerve can be compressed by a blood vessel, the pressure wearing away the nerve’s myelin sheath. The intense, stabbing pain occurs in the jaw, gums, forehead or elsewhere on the face.

Commonly Prescribed (On-Label) Drugs: Carbamazepine

Off-Label Prescription Drugs Breakthrough Options: Botulinum Toxin Type A, Gabapentin, Lamotrigine, Oxcarbazepine

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