From the Guidelines
Hydroxyzine is not generally considered effective for treating neuropathic pain or burning pain specifically. While hydroxyzine is an antihistamine commonly used for anxiety, allergic reactions, and as a sleep aid, it lacks the mechanisms needed to effectively target neuropathic pain pathways. For neuropathic pain, first-line treatments typically include anticonvulsants (such as gabapentin 300-1200mg three times daily or pregabalin 75-300mg twice daily), certain antidepressants (like duloxetine 30-60mg daily or amitriptyline 10-75mg at bedtime), or topical agents (such as lidocaine patches or capsaicin cream) 1. These medications work by modulating pain signals in the nervous system, stabilizing overactive nerves, or affecting neurotransmitters involved in pain perception. Hydroxyzine primarily works on histamine receptors and has some anticholinergic and sedative properties, which don't significantly impact the mechanisms underlying neuropathic pain.
Some key points to consider when treating neuropathic pain include:
- Assessing pain and establishing the diagnosis of neuropathic pain
- Identifying relevant comorbidities that might be relieved or exacerbated by treatment
- Explaining the diagnosis and treatment plan to the patient and establishing realistic expectations
- Considering first-line treatments such as anticonvulsants, certain antidepressants, or topical agents
- Evaluating patients for nonpharmacological treatments and initiating them if appropriate
While hydroxyzine might help with sleep or anxiety that can accompany chronic pain conditions, it should not be relied upon as a primary treatment for neuropathic pain itself. Patients experiencing neuropathic pain should consult with a healthcare provider to develop an appropriate treatment plan using medications with established efficacy for this specific type of pain 1. The most recent and highest quality study, published in 2023, recommends considering gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), sodium channel blockers, tricyclic antidepressants (TCAs), and SNRI/opioid dual-mechanism agents for the treatment of pain in diabetic peripheral neuropathy 1.
From the Research
Effectiveness of Hydroxyzine for Burning Pain
- There is no direct evidence in the provided studies to support the effectiveness of hydroxyzine for treating burning pain, specifically neuropathic pain 2, 3, 4, 5, 6.
- However, studies have shown that other medications such as gabapentin and pregabalin are effective in relieving neuropathic pain, including burning pain 2, 4, 5, 6.
- Gabapentin has been shown to relieve symptoms of allodynia, burning pain, shooting pain, and hyperesthesia in patients with neuropathic pain 2.
- Pregabalin has also been found to be effective in relieving pruritus and neuropathic pain in burn survivors 4.
- The use of gabapentin and pregabalin for neuropathic pain is well established, but the effectiveness of hydroxyzine for this condition is not supported by the provided evidence.
Alternative Treatments for Neuropathic Pain
- Gabapentin and pregabalin are commonly used to treat neuropathic pain, and their effectiveness has been demonstrated in several studies 2, 4, 5, 6.
- Other medications such as amitriptyline and duloxetine may also be used to treat neuropathic pain, although their effectiveness may vary depending on the individual patient 3, 5.
- The choice of treatment for neuropathic pain should be based on the individual patient's needs and medical history, and should be guided by a healthcare professional.
Dosage and Administration
- The effective dose of gabapentin for neuropathic pain can vary depending on the individual patient, but typical doses range from 900 to 3600 mg/day 2.
- Pregabalin doses for neuropathic pain typically range from 50 to 300 mg/day 3, 4.
- The dosage and administration of these medications should be guided by a healthcare professional to ensure safe and effective treatment.