The treatment of<unk>  varies based on the cause of the condition, and treating the underlying condition can aid in the management of<unk> . When<unk>  results from diabetes mellitus or prediabetes, blood sugar management is key to treatment. In prediabetes in particular, strict blood sugar control can significantly alter the course of<unk> . In<unk>  that stems from immune-mediated diseases, the underlying condition is treated with intravenous immunoglobulin or steroids. When<unk>  results from vitamin deficiencies or other disorders, those are treated as well. A 2009 Cochrane review states that there is no evidence from randomised trials on any form of treatment for neuralgic amyotrophy Medications A range of medications that act on the central nervous system have been used to symptomatically treat<unk> c pain. Commonly used medications include tricyclic antidepressants (such as nortriptyline, amitriptyline. imapramine, and desipramine,) serotonin-norepinephrine reuptake inhibitor (SNRI) medications (duloxetine, venlafaxine, and milnacipran) and antiepileptic medications (gabapentin, pregabalin, oxcarbazepine zonisamide levetiracetam, lamotrigine, topiramate, clonazepam, phenytoin, lacosamide, sodium valproate and carbamazepine). Opioid and opiate medications (such as buprenorphine, morphine, methadone, fentanyl, hydromorphone, tramadol and oxycodone) are also often used to treat<unk> c pain. As is revealed in many of the Cochrane systematic reviews listed below, studies of these medications for the treatment of<unk> c pain are often methodologically flawed and the evidence is potentially subject to major bias. In general, the evidence does not support the usage of antiepileptic and antidepressant medications for the treatment of<unk> c pain. Better designed clinical trials and further review from non-biased third parties are necessary to gauge just how useful for patients these medications truly are. Reviews of these systematic reviews are also necessary to assess for their failings. It is also often the case that the aforementioned medications are prescribed for<unk> c pain conditions for which they had not been explicitly tested on or for which controlled research is severely lacking; or even for which evidence suggests that these medications are not effective. The NHS for example explicitly state that amitriptyline and gabapentin can be used for treating the pain of sciatica. This is despite both the lack of high quality evidence that demonstrates efficacy of these medications for that symptom, and also the prominence of generally moderate to high quality evidence that reveals that antiepileptics in specific, including gabapentin, demonstrate no efficacy in treating it. Antidepressants In general, according to Cochrane's systematic reviews, antidepressants have shown to either be ineffective for the treatment of<unk> c pain or the evidence available is inconclusive. Evidence also tends to be tainted by bias or issues with the methodology. Cochrane systematically reviewed the evidence for the antidepressants nortriptyline, desipramine, venlafaxine and milnacipran and in all these cases found scant evidence to support their use for the treatment of<unk> c pain. All reviews were done between 2014 and 2015. A 2015 Cochrane systematic review of amitriptyline found that there was no evidence supporting the use of amitriptyline that did not possess inherent bias. The authors believe amitriptyline may have an effect in some patients but that the effect is overestimated. A 2014 Cochrane systematic review of imipramine notes that the evidence suggesting benefit were "methodologically flawed and potentially subject to major bias." A 2017 Cochrane systematic review assessed the benefit of antidepressant medications for several types of chronic non-cancer pains (including<unk> c pain) in children and adolescents and the authors found the evidence inconclusive. Antiepileptics A 2017 Cochrane systematic review found that daily dosages between (1800 - 3600) mg of gabapentin could provide good pain relief for pain associated with diabetic<unk>  only. This relief occurred for roughly (30 - 40)% of treated patients, while placebo had a (10 - 20)% response. Three of the seven authors of the review had conflicts of interest declared. In a 2019 Cochrane review of pregabalin the authors conclude that there is some evidence of efficacy in the treatment of pain deriving from post-herpetic neuralgia, diabetic<unk>  and post-traumatic<unk> c pain only. They also warned that many patients treated will have no benefit. Two of the five authors declared receiving payments from pharmaceutical companies. A 2017 Cochrane systematic review found that oxcarbazepine had little evidence to support its use for treating diabetic<unk> , radicular pain and other<unk> es. The authors also call for better studies. In a 2015 Cochrane systematic review the authors found a lack of evidence showing any effectiveness of zonisamide for the treatment of pain deriving from any<unk> . A 2014 Cochrane review found that studies of levetiracetam showed no indication for its effectiveness at treating pain from any<unk> . The authors also found that the evidence was possibly biased and that some patients experienced adverse events. A 2013 Cochrane systematic review concluded that there was high quality evidence to suggest that lamotrigine is not effective for treating<unk> c pain, even at high dosages (200 - 400) mg. A 2013 Cochrane systematic review of topimirate found that the included data had a strong likelihood of major bias; despite this, it found no effectiveness for the drug in treating the pain associated with diabetic<unk> . It had not been tested for any other type of<unk> . Cochrane reviews from 2012 of clonazepam and phenytoin uncovered no evidence of sufficient quality to support their use in chronic<unk> c pain." A 2012 Cochrane systematic review of lacosamide found it very likely that the drug is ineffective for treating<unk> c pain. The authors caution against positive interpretations of the evidence. For sodium valproate the authors of a 2011 Cochrane review found that "three studies no more than hint that sodium valproate may reduce pain in diabetic<unk> ". They discuss how there is a probable overestimate of effect due to the inherent problems with the data and conclude that the evidence does not support its usage. In a 2014 systematic review of carbamazepine the authors believe the drug to be of benefit for some people. No trials were considered greater than level III evidence; none were longer than 4 weeks in length or were deemed as having good reporting quality. A 2017 Cochrane systematic review aiming to assess the benefit of antiepileptic medications for several types of chronic non-cancer pains (including<unk> c pain) in children and adolescents found the evidence inconclusive. Two of the ten authors of this study declared receiving payments from pharmaceutical companies. Opioids A Cochrane review of buprenorphine, fentanyl, hydromorphone and morphine, all dated between 2015 and 2017, and all for the treatment of<unk> c pain, found that there was insufficient evidence to comment on their efficacy. Conflicts of interest were declared by the authors in this review. A 2017 Cochrane review of methadone found very low quality evidence, three studies of limited quality, of its efficacy and safety. They could not formulate any conclusions about its relative efficacy and safety compared to a placebo. For tramadol, Cochrane found that there was only modest information about the benefits of its usage for<unk> c pain. Studies were small, had potential risks of bias and apparent benefits increased with risk of bias. Overall the evidence was of low or very low quality and the authors state that it "does not provide a reliable indication of the likely effect". For oxycodone the authors found very low quality evidence showing its usefulness in treating diabetic<unk>  and postherpetic neuralgia only. One of the four authors declared receiving payments from pharmaceutical companies. More generally, a 2013 review examining the overall efficacy of opioid therapy for the treatment of<unk> c pain found studies were often subject to bias and that their efficacy and safety was not deducible with the evidence available. A 2017 Cochrane review examining opioid therapy as a treatment for many non-cancer pain syndromes (including<unk> c pain) concluded, "There was no evidence from randomised controlled trials to support or refute the use of opioids to treat chronic non-cancer pain in children and adolescents." Others A 2016 Cochrane review of paracetamol for the treatment of<unk> c pain concluded that its benefit alone or in combination with codeine or dihydrocodeine is unknown. Few studies have examined whether nonsteroidal anti-inflammatory drugs are effective in treating<unk> . There is some evidence that symptomatic relief from the pain of<unk>  may be obtained by application of topical capsaicin. Capsaicin is the factor that causes heat in chili peppers. However, the evidence suggesting that capsaicin applied to the skin reduces pain for<unk>  is of moderate to low quality and should be interpreted carefully before using this treatment option. Evidence supports the use of cannabinoids for some forms of<unk> c pain. A 2018 Cochrane review of cannabis-based medicines for the treatment of chronic<unk> c pain included 16 studies. All of these studies included THC as a pharmacological component of the test group. The authors rated the quality of evidence as very low to moderate. The primary outcome was quoted as, "Cannabis-based medicines may increase the number of people achieving 50% or greater pain relief compared with placebo" but "the evidence for improvement in Patient Global Impression of Change
Peripheral neuropathy
Limb–girdle muscular dystrophy
Arthropathy
Varicose veins
Myelopathy
Myopathy
Autonomic neuropathy
Optic neuropathy