Gabapentin plus venlafaxine-an effective treatment approach for nerve pain

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How often do you feel pins and needles in your arm? Do you experience numbness in your foot after prolonged sitting? are you noticing any sensory issues?

Take your time!

Well! Pain, regardless it is acute or chronic, is the most common complaint that has been reported in primary medical care settings.

Nerve pain is unique in terms of its duration, intensity, and severity. Whenever, your nerve is anatomically compromised, it starts hurting you.

Though, there are a variety of options available to treat the nerve pain, but, as the new drugs are introduced, the treatment options are widely extended.

Several medicines used to treat the seizures and depression disorder have also shown the tremendous results for relieving the pain associated with the nerve.

The standard protocol for relieving pain is rest, ice, compression, and elevation. No matter, how severe is the pain and what its frequency, this protocol is ideal for managing the nerve pain conservatively.

However, several therapeutic interventions, like nerve decompression technique, soft tissue massage, and TENS can also be used by the physical therapist as an adjunct of the medication to maximize the pain reduction and improve the overall quality of life.

Nevertheless, nerve pain is well-tolerated and people most likely report the pain to a doctor when it is difficult to treat.

How could you know that you’re experiencing the nerve pain?

Nerve pain has the different presentation as compared to other types of pain. The typical sign of nerve pain is sudden pins & needles, sharp, stinging pain radiating from one part to nearby areas.

Most of the diabetic patients experience neuropathy and if it left untreated, it could lead to infections, injury, and even, amputation.

According to Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital,’ people report like, my knee is hurting and the pain is radiating to the mid-thigh and it is going down to the shin. In such cases, the involvement of the nerve can be suspected’.

As nerve is the messenger providing the pain signals, its impingement or even damage can lead to the detrimental outcomes, including sensory loss, motor issues, and autonomic dysfunction.

Thus, it is unsafe to avoid the pain, especially, if you’re suffering from any metabolic disorder, including diabetes.

How can the combination of gabapentin and venlafaxine help in nerve pain reduction?

For easing the nerve pain, tons of medicines are available, but the combination of anticonvulsants (gabapentin) and antidepressant (venlafaxine) is becoming popular for providing nerve pain relief.

so, how anticonvulsants work for nerve pain reduction? Anticonvulsants are also known as anti-epileptic drugs, which is mainly categorized with gabapentin and pregabalin.

Though, it has been used to treat epilepsy or other seizure disorders, but due to its exceptional nerve-calming qualities, it can help to soothe the nerves when they’re hurting due to any underlying cause.

The most popular action of a mechanism of anticonvulsants is they taper down the hyperexcitability of nerves.

But, it is effective for treating the pain because, it interferes and relaxes the overactive pain signal’s transmission, which is rather sent by the damaged nerves or oversensitive nerves, like in fibromyalgia.

Also, another theory suggested that gabapentin affects the electrically charged ions-calcium and sodium to decrease the nerve pain.

According to AAN summary guideline for treating diabetic nerve pain, ‘strong evidence of effectiveness in treating diabetic nerve pain have been found.’

Perhaps, it should be started on a low dose initially to prevent the side effects. However, the dose also depends on the condition and its mechanism of pain production.

However, it usually takes four to six weeks for providing the complete effect, but your doctor may adjust the dosage according to several pain considerations.

Secondly, in what ways, the antidepressants are effective? still, the exact mechanism of how it works for easing nerve pain is unknown, but several theories have suggested that multiple mechanisms are responsible for soothing the pain signals from nerve.

 Gabapentin for nerve pain

One of the most famous theory is antidepressants work by exerting their effects on norepinephrine and serotonin.

Second theory reported that antidepressants provide the adjunctive therapeutic effects by regulating the histamine receptors along with the sodium channels modulation.

Depression is one of the most common conditions accompanied with the pain in patients. Various studies postulated the relationship of pain with depression. More pain you experience, more you’ll be in a depression.

Many antidepressants are available but their degree of effectiveness would vary significantly. Venlafaxine is a mixed-action antidepressant, characterized by two mechanisms that reduce the serotonin reuptake at low doses, whereas, at higher doses, it inhibits the norepinephrine reuptake.

So, it is different from SSRI’s and TCA’s because it is involved in the modulation of both key hormones of neuropathic pain.

some empirical studies suggested that the venlafaxine is an efficient drug for managing the neuropathic pain at doses of 150mg per day or higher (particularly at antidepressant dose).

Elevated blood pressure and discontinuation syndrome are the milder side effect of the venlafaxine.

With the help of a combination of venlafaxine and gabapentin, different mechanisms are allowed to provide the significant difference in the pain reduction.

If these drugs are used lonely, their effects may not be too much rapid, but, in the combination, these drugs provide the additional advantages, like improving sleep quality and relaxing your mind.

A study published in Journal of Clinical Neuromuscular Disease revealed that those diabetic patients who do not respond to gabapentin monotherapy have the drastic improvement in the neuropathic pain when they received the gabapentin and venlafaxine parallel.

Because antidepressants and anticonvulsants relieve the neuropathic pain through regulating and interacting with specific neurotransmitters and ion channels, if you take drugs in combination, the outcome will be good enough.

Another study recommended that the efficacy of venlafaxine and gabapentin has a comparable efficacy in patients experiencing the neuropathic pain, however, both may differ in side effect profiles, safety, and tolerability.

Hence, the effects of both drugs, namely, venlafaxine and gabapentin, are positive for getting optimal, and rapid relieve from neuropathic pain.