If alcohol use or abuse underlies the neuropathy, addiction control may provide a solution. In some cases, none of the above strategies is sufficient to immediately provide relief for the pain of neuropathy. For more persistent, less easily controlled pain, tricyclic antidepressants may be prescribed, since these alter the perception of pain. These drugs may interfere with normal liver function and reduce or increase blood levels of protease inhibitors and other drugs used to treat HIV infection. Narcotics such as hydrocodone, codeine and morphine are often reserved for intractable neuropathic pain because they can cause cognitive impairment and because some people develop tolerance, which limits their effectiveness.
Practical measures are useful in neuropathic pain control.
Thick socks and loose, soft-soled shoes may be helpful. Extreme changes in temperature may worsen the pain of neuropathy, so warm shoes or boots are important in winter and sandals may reduce neuropathic pain on warm days. Sitting with shoes removed for several minutes several times a day often provides relief. Nightly foot soaks with either cold or hot water before bed can relieve pain enough to allow sleep. Blanket supports that remove the pressure of bedding from the feet may also be helpful.