Pharmacotherapy for nerve pain

TherapyDrug classDrugsMechanism of actionAdverse effects
First-line therapyCalcium channel blockersGabapentinIt inhibits α2δ subunit of VGCCs.Peripheral swelling
PregabalinIt inhibits α2δ subunit of VGCCs.Peripheral swelling and increased bodyweight
TCAsAmitriptylineIt inhibits the reuptake of serotonin and norepinephrine.Arrhythmia and suicide risk
SNRIDuloxetine, venlafaxineThese act by inhibiting the reuptake of serotonin and norepinephrine.Ataxia, hyperhidrosis and hypertension
Second-line therapyOpioidsTramadolIt acts by binding to opioid receptors.Seizures and ataxia
TapentadolIt inhibits the reuptake of serotonin and norepinephrine.Seizures and ataxia
Topical treatmentsLidocaineIt acts by binding to sodium channels.Local erythema, itching and pain
CapsaicinIt interacts chemically with sensory neurons for its action.Pain and itching
Third-line therapyStrong opioidsMorphineIt acts by binding to opioid receptors.Dizziness and lethargy
NeurotoxinsBotulinum toxinIt acts by decreasing the release of acetylcholine.Pain at injection site

SNRI: serotonin-norepinephrine reuptake inhibitors; TCAs: tricyclic antidepressants; VGCCs: voltage-gated calcium channels