Topical Options for Nerve Pain Relief Without Systemic Side Effects

johnhayesjr1
13 minutes ago
2 min read

When a patient with peripheral neuropathy says, “I don’t want more pills,” they’re not being difficult, they’re being honest. Many are already dealing with medication fatigue, side effects, and a sense that symptom relief shouldn’t require sedation.

That’s where topical therapies come in. As an independent physician, you’re in a powerful position to offer non-systemic, targeted treatments that support pain relief while protecting cognition, energy, and function.

Why Topicals Make Sense for Neuropathy

Topical options work by delivering active ingredients directly to affected areas, with minimal systemic absorption. This means:

Fewer side effects
No sedation or GI impact
Better adherence and comfort
Synergistic use with other therapies (laser, nutrition, rehab)

Best of all, they empower patients who feel stuck between pain and unwanted prescriptions.

Evidence-Based Topicals to Consider

1. Capsaicin (Low or High-Dose)

Derived from chili peppers
Depletes substance P (a pain neurotransmitter)
Useful for localized burning or tingling
May cause mild initial irritation but improves with use

2. Lidocaine 5% Patch or Gel

Sodium channel blocker
Ideal for focal nerve pain or post-herpetic neuralgia
Useful for patients needing temporary relief during activities or sleep

3. Ketamine/Gabapentin/Amitriptyline Creams (Compounded)

NMDA receptor and calcium channel modulation
Can be tailored to patient needs
A good alternative for those weaning off oral meds

4. CBD or Full-Spectrum Hemp Creams

Anti-inflammatory and analgesic properties
Emerging data supports its use in neuropathic conditions
Low risk, high patient interest

Bringing It Into Your Practice

You can:

Recommend evidence-based OTC or compounded topicals
Partner with local compounding pharmacies for custom blends
Educate patients on when and how to use them
Combine topicals with regenerative protocols (e.g., laser, nutrition) for best results

Want to Expand Your Non-Drug Pain Management Toolkit?

Book a Strategy Session with John Hayes Jr., MD to learn how physicians are using topical treatments as part of a complete, functional approach to neuropathy, no sedation required.