How is it treated?
neuropathiehiv008004.jpg neuropathiehiv008003.jpg neuropathiehiv008002.jpg sq_redsm.gif sq_redsm.gif sq_redsm.gif sq_redsm.gif Why neuropathy with HIV? Home Other options or alternatives BLOG (help for the community) sq_redsm.gif What is neuropathy? sq_redsm.gif Site in Dutch sq_redsm.gif Links
No drug has been approved to repair or 'cure' nerve damage although peripheral nerves have the ability to regenerate, as long as the nerve cell itself is not dead. Symptoms can often be controlled and eliminating the specific causes of forms of neuropathy can prevent new damage.
The type of neuropathy treatment that will work best for an individual will vary widely depending on the cause of the pain and whether or not the patient suffers from other conditions.

In principle, any other underlying conditions are treated first, followed by symptomatic treatment for neuropathy.

For HIV patients the first step is to establish whether any drugs in your combination therapy are known neuropathy causes - if so and if it's safe to do so, then stopping those drugs, or substituting them for a better alternative is the first line of treatment. 


Don't be alarmed by the number of brand names and pharmaceutical descriptions of drugs which follow. It seems a complex list but the likelihood is that you will come across one or more of these drugs during your treatment. Hopefully, you'll only need the one which is a success but actually there aren't that many options open to doctors and neuropathy is one of those diseases which tends to confound the norms. What works for one may not work for know the story. 

                                                       Pain killers    

We live in a culture where drugs are both available and freely given but as an HIV patient you will already understand the general rule; the fewer the better. However neuropathy is a remorseless disease for some people and drugs are necessary to control the pain.

Mild symptoms may be relieved by over-the-counter pain medications like paracetemol, ibuprofen and aspirin but watch out for stomach problems. If the symptoms are more severe, your doctor may recommend prescription painkillers. Drugs containing opiates, such as codeine, can lead to dependence, constipation or sedation, so these drugs are generally prescribed only when other treatments fail however many people end up on drugs from the morphine family because nothing else will help.        

However, as you know, prescription drugs only relive the pain for a limited time and do nothing to improve the condition itself. They may provide some level of temporary relief but as the disease progresses, the dosage of the drug needed to continue suppressing the pain effectively may need to increase concurrently possibly leading to addiction. The side effects of these types of drugs can also be difficult to deal with and even increase your problems. When the increased drug dosage reaches a threshold level, the patient can become exposed to symptoms that seem far worse than the original illness. Symptoms similar to Alzheimer’s can follow. Many people see that as an acceptable risk so long as the quality of life is improved through less pain.
Good relationships with your health care professionals are clearly important but although they're the experts, don't let them bully you - it's your body. Try to resist moving on to the more powerful drugs for as long as you can and always talk over the possibility of stopping them with your doctor. Withdrawal symptoms can be very unpleasant so everything needs to be thought through but it has been known for neuropathy patients to stop the morphine type drugs because they have helped and in some cases have reversed the pain. It helps your decision making, if you are aware of the possible side effects of your drugs but most HIV patients are used to doing their own research when it comes to their treatment.

Remember, every drug you take may have an effect on your HIV medication - always check with the doctor.

analgesics (e.g., aspirin, ibuprofen) are usually ineffective against pain caused by neuropathy, treatment often involves medications that target nerve cells. However, Paracetemol (up to 6 x 500mg per day) is often recommended as a starter and may help with pain due to muscular tension and is also kinder to your stomach.

                                                   Other drugs

put, most of the following drugs are intended to interrupt, confuse or suppress the electrical and chemical activity of the nerves and the pain impulses to the brain, thus reducing the symptoms of neuropathy.

Tricyclic antidepressant medications, such as amitriptyline and nortriptyline (Pamelor), were originally developed to treat depression. However, they have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain. The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) also has proved effective for peripheral neuropathy caused by diabetes. Side effects may include nausea, drowsiness, dizziness, decreased appetite and constipation.

Anti-seizure medications.
Drugs such as gabapentin (Neurontin), topiramate (Topamax), pregabalin (Lyrica), carbamazepine (Tegretol) and phenytoin (Dilantin) were originally developed to treat epilepsy. However, doctors often also prescribe them for nerve pain. Side effects of these drugs include drowsiness, dizziness, low blood pressure, and fatigue.
Carbamazapine often results in over-sensitivity, or liver problems or interactions with HIV medication. The other drugs mentioned (Pregabalin, gabapentin) don't carry this risk. 
Pregabalin (Lyrica®) has been approved by the Food and Drug Administration (FDA) to treat post-herpetic neuralgia (shingles pain). Common side effects include drowsiness, dizziness, nausea, weight gain, and swelling (oedema).

Other medications include the anticonvulsants (e.g., Carbamazepine [Tegretol®], Lamotrigine [Lamictal®]), local anaesthetics (e.g., Lidocaine [Xylocaine®]), and antiarrhythmics (e.g., Mexiletine [Mexitil®]). Anticonvulsants may cause low white blood cell counts, nausea, vomiting, and dizziness. Side effects of lidocaine and mexiletine include nervousness, light-headedness, drowsiness, and double vision.

Lidocaine patches.
This patch contains the topical anaesthetic lidocaine. You apply it to the area where your pain is most severe, and you can use up to four patches a day to relieve pain. This treatment has almost no side effects except, for some people, a rash at the site of the patch.
Topical treatment with Capsaicin cream (Zostrix) may be prescribed for neuropathy patients. Capsaicin (red hot chilli peppers!) causes stinging upon application and is often combined with a local anaesthetic to reduce this side effect. Axsain (.25% capsaicin in Lidocarevehicle) contains a higher dose of capsaicin in a cream that reduces stinging and burning. Lidoderm(lidocaine patch 5%) has been shown to be helpful for localized areas of tingling or burning but is not available or approved in all countries. 

                                               Injection Therapy

Injection therapy involves injecting a nerve block (e.g., lidocaine) into the area surrounding affected nerves, preventing the nerve from carrying impulses to the brain and temporarily reducing symptoms. Injection therapy is often used with other treatments (e.g., medication, physical therapy).
Combination Therapy
Combination therapy regarding neuropathy has not been widely researched but there are sufficient cases to warrant a paper being published in The Lancet. Normal medication research compares the performance of one medicine against a placebo but with problems such as high blood pressure, asthma, HIV and cancer, the effectiveness of combining drugs te achieve an successful treatment are widely known.
With a condition such as neuropathy where the success of mono-therapy is limited to say the least, it seems logical that research into combination therapies could be widened. Thus far, studies have been made into combining gabapentine with nortriptyline, morphine and oxycodon. The results seem promising but this site does not have sufficient information to form an opinion. It should at least be enough to start a conversation with your doctor or specialist to explore the possibilities.
 Link to Blog Post