Damage or disease of the nerves. The most common form of neuropathy is peripheral neuropathy, which affects more than 20 million Americans. Peripheral neuropathies can be caused by diabetes, vitamin B12 or folate deficiency, drugs, environmental toxins, cancer, excessive alcohol consumption, injuries, infections such as Lyme disease, shingles, HIV infection or connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus or Sjögren’s syndrome. Symptoms of peripheral neuropathy can vary widely and can include numbness, tingling, burning, a “pins and needles” sensation and muscle weakness.
Peripheral neuropathy is first treated by addressing any underlying conditions that may be causing it. Mild pain can be treated with over-the-counter painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs). If these measures fail to control symptoms, a variety of other medications can be used. These may include tricyclic antidepressants such as amitriptyline; antidepressants called serotonin-norepinephrine reuptake inhibitors such as duloxetine hydrochloride or venlafaxine; anticonvulsant medications such as gabapentin, pregabalin, topiramate and carbamazepine; and antiarrhythmic medications such as mexiletine. When all other measures fail, opioid medications such as tapentadol may be used. Topically administered medicines such as lidocaine or capsaicin may help. Other measures that may help alleviate symptoms include massage, acupuncture (an ancient Chinese treatment in which hair-thin needles are inserted into the skin) and transcutaneous electrical nerve stimulation (TENS), a noninvasive intervention for pain relief that involves delivering gentle electric current to the skin at the site of the pain.