Neuropathic Pain Support Protocol
Primary Stack
Core supplements with strongest evidenceAntioxidant; evidence for diabetic neuropathy pain
Supporting Studies (1)
Supports nerve regeneration; reduces neuropathic pain
Supporting Studies (1)
Supporting Stack
Additional supplements for enhanced resultsEssential for nerve health; deficiency causes neuropathy
Supporting Studies (1)
Fat-soluble B1; blocks pathways causing nerve damage in diabetes
Supporting Studies (1)
Depletes substance P; reduces localized neuropathic pain
Supporting Studies (1)
How This Protocol Works
Simple Explanation
Neuropathic pain is caused by damage or disease affecting the nervous system. It's often described as burning, shooting, stabbing, or electric shock-like pain, and can be difficult to treat.
COMMON CAUSES:
SYMPTOMS:
CRITICAL: Neuropathic pain requires comprehensive medical evaluation and treatment. This protocol is SUPPORTIVE ONLY.
MEDICAL TREATMENTS:
LIFESTYLE MEASURES:
* Alpha-lipoic acid has evidence for diabetic neuropathy.
* B vitamins support nerve health and repair.
* Topical capsaicin can help localized pain.
Expected timeline: Supplements may take 4-8 weeks to show benefit. Neuropathic pain is often chronic and requires multimodal management.
Clinical Perspective
Neuropathic Pain: Pain from nervous system damage/disease. Common causes: diabetic neuropathy, postherpetic neuralgia, chemotherapy-induced, traumatic. Diagnosis: clinical; screening tools (DN4, painDETECT). Treatment is often challenging; multimodal approach needed.
Treatment: First-line medications: gabapentinoids (pregabalin, gabapentin), SNRIs (duloxetine), TCAs (amitriptyline). Start low, titrate slowly. Combination therapy often needed. Alpha-lipoic acid and B vitamins have evidence, especially for diabetic neuropathy. Topical capsaicin for localized pain. Address underlying cause when possible.
* Alpha-Lipoic Acid (B-grade): Antioxidant/nerve. Meta-analysis: (PMID: 25515216). 600-1200mg daily.
* Acetyl-L-Carnitine (B-grade): Nerve regeneration. Systematic review: (PMID: 23597877). 1500-3000mg daily.
* Vitamin B12 (B-grade): Nerve health. Systematic review: (PMID: 27450775). 1000-2000mcg daily.
* Benfotiamine (B-grade): Diabetic neuropathy. Clinical trials: (PMID: 25248250). 300-600mg daily.
* Capsaicin (B-grade topical): Substance P depletion. Cochrane: (PMID: 23881906). 0.025-0.075% TID-QID.
Assessment targets: Pain scores (NRS), function, sleep, quality of life.
Protocol notes: Diabetic neuropathy: glycemic control most important; ALA has best supplement evidence (600mg IV superior to oral initially). Gabapentin/pregabalin: start low, titrate; may take weeks for effect. Duloxetine: good for painful diabetic neuropathy; 60mg effective. Amitriptyline: effective but anticholinergic side effects. Combination: often more effective than monotherapy. Capsaicin: wash hands after application; initial burning common. B12: check level; methylcobalamin may be superior to cyanocobalamin. Physical therapy: improves function even if pain persists. Psychological: pain psychology, CBT helpful for coping. Referral: pain specialist if refractory.