Question

What can I do about neuropathic pain?

28 November 2012. Related: All topics, Side effects.

Hi,

I have been using ART for 12 years.

In the past I took d4T,ddI, and isoniazid.

I have neuropathic pain and have tried so many medicines to improve it [pregabalin, amitriptyline,gabapentin, mecobalamin,alpha lipoic acid].

I’ve been taking these medicines for 3 years and it’s not getting better. What can I do?

Answer

Answer: Rebecca McDowall

Hello,

I’m very sorry to hear about the neuropathic pain you are experiencing. Peripheral neuropathy is associated d4T, ddI and isoniazid. When these medicines are used together the risk of developing neuropathy increases. Are you still taking any of these medicines?

Moderate and severe neuropathy is usually permanent, although it may improve after changing treatments. Unfortunately there is no approved treatment to repair nerve damage.  Treatments prescribed to manage neuropathy are basically used to mask the pain.

Although the treatments you have tried so far haven’t been effective there are many types of pain management. It’s important to try to find something to manage this pain. If possible you should be referred to a specialist pain-management clinic.

Opiate-based painkillers such as codeine, dihydrocodeine, fentanyl, methadone, morphine and tramadol sometimes help when the pain is severe.

Although not always appropriate for neurological damage, they sometimes help. It can take several days to find the appropriate dose, and these drugs can interact with some HIV drugs. A side effect of opiates is constipation.

Cannabis (marijuana), or synthetic versions such as nabilone (Cesamet) ordronabinol (Marinol) have been used to reduce pain related to neuropathy. They can be prescribed in the UK.

More rarely, when pain is so great that it is not treatable, alcohol can be injected into a nerve junction. Nerve blocks can be very effective when they work, and are a specialist procedure, but can also cause loss of sensation and sometimes produce unpredictable results.

There’s more information about neuropathy management, and links to further information in our side effects guide.