Nerve pain, also called neuropathic pain, is distinctive and probably one of the hardest types of pain to manage. Its cause can be difficult to figure out, but nerve involvement is a common component of many types of pain. 

Sometimes there is an obvious reason, such as when arthritis or a herniated disc puts pressure on a nerve in or near the spinal cord. Other times, the culprit may be direct trauma to a nerve or an underlying illness that affects one or more nerves.

Special tests, like MRIs and nerve-conduction studies, might help establish a diagnosis. In these cases, treating the primary illness can eventually also improve or even cure the pain.

Most often, however, tests don't clearly identify a cause for the pain. And even when they do, it can take some time before the pain is brought under control.   

Whenever a patient describes any neuropathic characteristics of their pain, I consider one or more of these categories of medication to help reduce the nerve pain:  

• Tricyclic antidepressants (TCAs). Many people decline these medicines because of the word "antidepressant." But the dose necessary to treat nerve pain is actually much lower than that needed to treat depression. This is an older class of medicine and is not often prescribed for depression anymore. In the lower doses used for nerve pain, the most common side effects are drowsiness, dry mouth, increased appetite, and constipation. If you're having trouble sleeping, bothered by diarrhea, or in fact do have some depression, this might be a great choice for you.
  
• Serotonin norepinephrine reuptake inhibitors (SNRIs). These are also antidepressants and are similar to the popular SSRIs (selective serotonin reuptake inhibitors). And, like the TCAs, SNRIs are often resisted by patients. But if you have even a mild case of low mood or if you can get past the depression "stigma," the SNRIs are very good at treating nerve pain. SNRIs often have a stimulating effect, and may be an excellent choice as a morning medication for people who suffer from fatigue.
  
• Anti-seizure medications. Like seizures, nerve pain often results from undesirable nerve signals. These medications help to decrease those unwanted nerve signals. Common side effects include nausea, loss of appetite, difficulty thinking clearly, and flu-like symptoms. Starting with a low dose and gradually increasing over several weeks or months usually minimizes those problems. These medications should not be stopped suddenly but should be tapered gradually to avoid causing a seizure.
  
• Narcotics. These powerful medications are remarkably effective for treating nerve pain. However, because of their potential for abuse and dependency, I recommend trying all of the other options first.

If a single drug doesn't effectively reduce your nerve pain, the above categories can be used in combination or with other over-the-counter or prescription medicines as part of an overall pain management plan.