Drugs | Therapy of a polyneuropathy


So-called non-opioid analgesics are painkillers that do not belong to the group of opioids. Commonly used examples are ASA (aspirin), paracetamol and metamizole (novalgin). These drugs are generally not very effective against neuropathic pain.

They also cause severe side effects when taken over a long period of time, such as gastrointestinal ulcers (gastrointestinal ulcer) or kidney and liver damage. Opioids are therefore the painkillers of choice. Many patients suffering from polyneuropathy respond positively to opioid analgesics.

For example, scientific studies have shown that the drugs tramadol and oxycodone provide relief from neuropathic pain. Oxycodone has been shown to be particularly effective in diabetic pain. The dosage is initially based on basic therapies.

If these do not produce the desired result, the dosage can be slowly increased. Before highly effective opioids are used, the previous treatment potential must be fully exploited. The administration of long-acting drugs in the form of tablets or patches is the drug of choice.

Although opioid analgesics are not very toxic to organs such as the liver and kidneys, they should be regularly monitored by laboratory tests. If treatment with opioids does not work, the therapy must be discontinued. When opioid analgesics are taken, various side effects may occur, which may affect the patient’s cooperation.

Digestive tract complaints such as constipation, nausea and vomiting play an important role. These undesirable drug effects can be circumvented with the help of anti-breaking and laxative drugs. If the patient already has digestive disorders before treatment, therapy must not be started.

Furthermore, in some cases opioids affect the nervous system and the psyche of the patient – fatigue, dizziness, confusion and hallucinations may occur. If the patient has an addiction problem (the patient is dependent on medication or drugs), the use of opioid analgesics is not recommended. These can lead to dependence and tolerance development during long-term therapy.

Tolerance development means that ever higher doses are needed to achieve the desired pain-relieving effect. Due to the potential for dependency, the drugs must be slowly reduced in dosage when discontinued in order to avoid withdrawal symptoms. Although this group of drugs is primarily used to treat depression, it can also influence the perception of pain.

Among other things, antidepressants suppress the signal transmission of pain fibers in the spinal cord. To prevent side effects, treatment is started with a very low dose, which is slowly increased until the desired effect is achieved. By checking the level of the medication in the blood, the dose can be well controlled.

If side effects do occur, they are manifested, for example, in blood pressure fluctuations and heart rhythm disturbances, nausea and vomiting, problems urinating or neurological-psychiatric symptoms such as forgetfulness, tiredness and sleep disorders. Medications that are used as standard in this context include amitriptyline, duloxetine and venlafaxine. In diabetic polyneuropathy, alpha-lipoic acid can be used to relieve pain.

The drug improves the blood supply to the nerves and thus not only treats the symptoms but also eliminates the cause of their development. Although damage that is too severe cannot be reversed, alpha-lipoic acid is an alternative to other drugs used in polyneuropathy despite its side effects due to its good tolerability.Gabapentin is primarily a drug used to treat epilepsy and seizures, but it has also been shown to be effective against polyneuropathic pain. The dosage should be strictly monitored by the treating physician and adjusted to the individual kidney function.

Only a few side effects have been described, which are mainly limited to fatigue and dizziness. In general, gabapentin is well tolerated and rarely needs to be discontinued due to its efficacy profile. Water retention (edema) may occur.

Lyrica® is the trade name of pregabalin which, like gabapentin, is primarily prescribed for the treatment of epilepsy and spasms. The administration of Lyrica® relieves the pain of many patients with polyneuropathy. Although the dose of this drug must also be adjusted to the kidney function, many patients experience improved sleep patterns regardless of the dose.

The side effects are mainly limited to fatigue and dizziness as well as weight gain. An increase in weight can reduce the patient’s cooperation, which is why good doctor-patient contact is essential. Edema (water retention) is also possible when taking Lyrica®.