Neuropathy (often called peripheral neuropathy) is nerve damage that can cause burning, tingling, numbness, stabbing pain, or “pins and needles.” It can affect the feet, legs, hands, or other areas. Many people ask the same big question:
“What is the best medication for this pain?”
Here’s the honest answer: there isn’t one single “best” medication for everyone. The best choice depends on what’s causing the nerve problem, your symptoms, your other health conditions, your sleep, your job (like driving), and how your body handles side effects. An effective plan often combines medication with non-pharmacological treatments and lifestyle changes.
A nurse practitioner (NP) can help by finding the cause, choosing safer medications, and adjusting them over time. An integrative chiropractor can help by improving movement, reducing mechanical stress on irritated nerves, building strength/balance, and using non-invasive therapies to support comfort and function. In integrative clinics, it’s also common to evaluate whether symptoms that feel like “neuropathy” are partly coming from nerve irritation in the spine, hip, or pelvis (a different problem with a different plan).
What Neuropathy Pain Really Is (and Why Cause Matters)
Neuropathic pain differs from “regular” pain. With neuropathy, damaged or irritated nerves can misfire, sending pain signals even when there’s no new injury. That’s why people may feel:
Burning or electric shocks
Tingling, buzzing, or “crawling” sensations
Numbness (sometimes with pain at the same time)
Worse symptoms at night
Balance problems or trouble sensing the floor
Identifying the cause is important because some causes can be treated or mitigated, thereby slowing disease progression. A careful medical evaluation often includes a focused neurologic examination and laboratory tests to identify common contributors (e.g., diabetes, vitamin deficiencies, thyroid disorders, kidney disease, and others).
“What Is the Best Medication for This Pain?”
Most modern guidelines and reviews describe several first-line medication options for neuropathic pain. The goal is usually not “zero pain overnight.” The goal is meaningful relief with the fewest side effects, plus better sleep and better daily function.
Common first-line medication categories
Gabapentinoids (gabapentin or pregabalin)
These are widely used because they can reduce nerve pain signaling.
What people often notice (possible side effects):
Sleepiness or dizziness
Slower thinking or “brain fog”
Swelling in the legs/feet
Weight gain (more common for some people)
Important safety note: These medications can affect alertness—so the NP often discusses driving safety, fall risk, and how to start low and adjust carefully.
SNRIs (especially duloxetine)
SNRIs are antidepressants that also work on pain pathways. They can help with neuropathic pain even when depression is not the main issue.
Common side effects people ask about:
Nausea or stomach upset at first
Dry mouth
Sleep changes (sleepy or wired)
Sweating or mild blood pressure changes (varies by person)
TCAs (like amitriptyline)
These are older antidepressants that can help nerve pain, but side effects can limit use in some people (especially older adults).
Common side effects:
Dry mouth, constipation
Sleepiness
Lightheadedness
Not ideal for everyone (the NP screens for safety risks)
Topical options (lidocaine or capsaicin)
If pain is localized (e.g., a patch of burning on the foot), topical treatments may be effective without many whole-body side effects.
Topical lidocaine can reduce surface nerve pain signals.
Capsaicin products can help some people but may initially cause a strong burning sensation (this varies by product and strength).
What about diabetic neuropathy specifically?
With painful diabetic neuropathy, a major expert statement notes that pregabalin or duloxetine are commonly considered initial medication choices, with other options used based on the individual situation. It also emphasizes that opioids are not recommended as first- or second-line choices for long-term management.
“Are There Non-Drug Treatments Available?”
Yes—and for many people, non-drug care is not “extra.” It’s a key part of the plan. Some non-drug options aim to reduce symptoms; others aim to improve safety, strength, balance, and quality of life.
Common non-drug strategies that often help
Movement and exercise (done safely): regular activity can support circulation, strength, and mood.
Foot and skin checks: neuropathy can make small injuries easy to miss.
Diabetes support: Tighter glycemic control can help slow the progression of diabetic neuropathy.
Smoking reduction/cessation and limiting heavy alcohol use: both can affect nerve health.
Home safety changes: neuropathy can increase fall risk (better lighting, clear walkways, stable footwear).
Where an integrative chiropractor can fit
In integrative settings, chiropractic care is not treated like a “one-trick” solution. It’s often used as part of a broader plan to:
Check for mechanical contributors (spine/hip/ankle mobility issues, gait problems, postural strain)
Build a home exercise plan focused on stability, balance, and safe strength
Use supportive therapies (which may include soft tissue work, mobility work, and other non-invasive modalities, depending on the clinic)
Coordinate with NP care when medication timing, sleep, and activity levels are being adjusted
Clinical observations shared in Dr. Alexander Jimenez’s integrative model emphasize examining the full picture—neurologic signs, musculoskeletal mechanics, mobility, and daily function—so that care is matched to the real driver(s) of symptoms, not just the label “neuropathy.”
“Why Is My Pain Worse at Night?”
This is extremely common. Several practical reasons can stack together:
Fewer distractions: when your day gets quiet, your brain notices pain more acutely.
Temperature changes: cooler nighttime temperatures and body temperature shifts may increase symptoms for some people.
Poor sleep is associated with higher pain sensitivity: low-quality sleep can make pain feel more intense.
Stress and anxiety: emotions can amplify pain signaling.
Medication timing: the dose schedule may not adequately cover the night, particularly with shorter-acting agents.
Simple nighttime steps that many patients try (with their clinician’s guidance)
Keep a consistent sleep schedule
Avoid alcohol close to bedtime
Use gentle stretching or breathing to reduce stress arousal
Ask the NP whether medication timing should be adjusted (never change on your own)
“What Can I Do If My Medication Isn’t Working?”
When a medication isn’t working, the next step isn’t always “stronger meds.” Often it’s a better strategy.
Here’s a common step-by-step approach an NP may use:
Step 1: Confirm the diagnosis
Is it truly peripheral neuropathy, or could it be radiculopathy (pinched nerve), entrapment, vascular issues, or another condition?
Step 2: Check for treatable drivers
Blood sugar control, vitamin issues, thyroid problems, kidney problems, medication side effects, alcohol exposure, and more can matter.
Step 3: Adjust the plan safely
Some individuals require a gradual increase (to limit side effects).
Some do better switching classes (for example, gabapentin-type → SNRI-type).
Step 4: Consider combination care
A lower dose of two approaches may be more effective than increasing a single medication to a high dose (this is individualized and clinician-guided).
Step 5: Add non-drug support
Target sleep, movement, balance, and safety—because function is the long game.
How a Nurse Practitioner Helps (Real-World, Practical Care)
An NP can be the “quarterback” of neuropathy care because neuropathy often connects to multiple body systems.
NP care commonly includes:
Finding and tracking the cause (history, exam, labs, and referrals when needed)
Medication selection and safety monitoring
Side effects, falls, driving safety, interactions, and follow-up planning
Setting expectations
Pain reduction goals, sleep goals, function goals (walking, work tolerance, daily comfort)
Coordinating the team
Neurology, podiatry, physical therapy, chiropractic, nutrition support—based on the person
How an Integrative Chiropractor Helps (Without Replacing Medical Care)
Chiropractic care does not “replace” medication management for many patients—but it can make the plan stronger when it focuses on function.
Common supportive roles include:
Mechanical screening
Are symptoms being worsened by movement patterns, posture, spinal/hip stiffness, or nerve irritation areas?
Rehab-based exercises
Balance work, ankle/foot strength, hip stability, safe walking progression
Fall-risk and home safety coaching
Reinforcing the “daily safety” habits that matter with reduced sensation
Integrative coordination
Helping the person stay active while the NP fine-tunes medication and sleep strategies
A Simple “Combo Plan” Example (Medication + Integrative Care)
A combined NP + integrative chiropractic plan often aims to:
Reduce pain intensity
Improve sleep
Improve walking tolerance and balance
Protect feet/hands and reduce injury risk
Slow progression by treating underlying drivers
Example components might include:
NP-guided trial of a first-line medication class (with follow-up)
Sleep/timing strategy for nighttime flare-ups
A movement plan that is safe and repeatable
Chiropractic-integrated rehab and mobility support to improve function
Clear safety steps (skin checks, driving discussion if numbness is significant)
When to Seek Medical Care Quickly
Get urgent evaluation (ER or urgent clinic guidance) if you have:
Sudden or rapidly worsening weakness
New loss of bowel or bladder control
Major new numbness in a “saddle” area
A hot, red, swollen foot wound (especially with diabetes)
Severe new symptoms after a fall or injury
Also, don’t wait months if neuropathy is progressing—earlier evaluation can matter.
Key Takeaways
No single “best” medication fits everyone. First-line options often include gabapentin/pregabalin, duloxetine, TCAs, and topical lidocaine/capsaicin, depending on the case.
Painful diabetic neuropathy commonly starts with options like pregabalin or duloxetine, and long-term opioids are not recommended as early-line choices.
Night pain is common due to distraction changes, temperature, sleep quality, stress, and medication timing.
The best outcomes often come from medication + non-drug care, with the NP managing the medical plan and the integrative chiropractor supporting movement, mechanics, and function.
References
American Academy of Family Physicians. (2020). Peripheral Neuropathy: Evaluation and Differential Diagnosis.
National Health Service. (2022). Peripheral Neuropathy: Treatment.
Fornasari, D. (2017). Pharmacotherapy for Neuropathic Pain: A Review. (PMC)
Pop-Busui, R., et al. (2017). Diabetic Neuropathy: A Position Statement by the American Diabetes Association. (PMC)
Cleveland Clinic. (2020). Why Is Neuropathy Worse at Night?.
Memorial Sloan Kettering Cancer Center. (n.d.). Managing Peripheral Neuropathy.
El Paso Back Clinic. (n.d.). Common Questions About Neuropathy in El Paso, TX: Solutions.
Jimenez, A. (2026). Dr. Alexander Jimenez – Clinical Observations & Integrative Care Resources
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed to practice. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and to identify relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. To discuss the subject matter above further, please contact Dr. Alex Jimenez or us at 915-50-0900.
Dr. Alex Jimenez, DC, MSACP, CCST, IFMCP*, CIFM*, ATN*
Email: coach@elpasofunctionalmedicine.com
Licensed in: Texas & New Mexico*
