What if there were medical options for nerve pain with fewer whole-body side effects?

If you experience nerve pain from something like sciatica, multiple sclerosis, diabetic neuropathy or something else, you probably know how debilitating, unpredictable and at times intense this pain can be.

You may have also already tried different methods to help with the pain, which may have included medications such as Lyrica, Gabapentin, Endep or others.

For some people, these can be effective in helping to manage their pain. However, for others, the side effects can be difficult to tolerate, and what works can vary significantly between individuals.

Topical agents, which are products applied to the skin, are often considered a more tolerable option for some people. These agents primarily act locally in the tissue underneath the skin, rather than having the same level of systemic effects as some oral medications.

A recent paper was released by the American Academy of Pain Medicine Foundation to provide information and guidance on the use of these medications.

This consensus statement, which represents agreed recommendations from a group of experts in nerve pain, reviewed the current research in this area.

So what came out of this consensus:

1. The consensus found relatively strong evidence supporting the use of Capsaicin for diabetic peripheral neuropathy, postherpetic neuralgia and HIV induced neuropathy
   

2. Fewer and generally less severe side effects were reported in some studies compared to oral medications
   

3. There was lower strength of evidence or limited evidence for many other topical options

Some limitations to the paper - where we need to be cautious when interpreting the findings:

• It included smaller studies and non randomised controlled trials, rather than consistently using higher quality study designs
  

• These recommendations are based on expert consensus, which, while informed by research, still involves interpretation
  

• Although it aimed to be inclusive of different types of nerve pain, there was limited research available for several conditions
  

• It primarily looked at short term risks rather than long term outcomes
  

• As with all research, this represents one piece of the broader evidence base, and findings may evolve over time

As with all medications, it is strongly recommended to discuss options with your GP or specialist. Even non prescription medications can carry risks, including side effects, interactions with other medications, and individual sensitivities. Prescription medications are also regulated and tailored to your specific needs.

Reference

Lawson, E., Singla, P., Adler, J., Argoff, C. E., Bettinger, J. J., Bhaskar, A., Clarke, H., Eidelman, A., Hirani, S., Hooten, W. M., Tishler, J., Wallace, M. S., & Barreveld, A. M. (2026). Topical analgesics for

neuropathic pain: an evidence-informed guide for the practicing clinician. Pain medicine (Malden, Mass.), 27(3), 279–316. https://doi.org/10.1093/pm/pnaf130

Disclaimer

This information is for educational purposes only and is not a substitute for personal medical advice. These blogs are written by Sam Bulten and represent his opinions and insights and are based on his experience and interpretation of the research. As Sam is a human, these opinions and insights are not absolute truths.

Written by

Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement