Neuropathy is a debilitating type of pain caused by injury or damage to nerves. Although many factors lead to neuropathy, the imbalance between damaging free radicals and protective antioxidants (oxidative stress) is a significant contributor. 

Some supplements may help manage neuropathic pain. Anti-inflammatory and antioxidant supplements may reduce nerve damage and improve symptoms of neuropathy. However, whether research supports the use of these supplements for neuropathy is not well established.

1. Acetyl-L-Carnitine

Acetyl-L-carnitine is a naturally occurring amino acid. It reduces the number of pro-inflammatory molecules in the body and helps produce proteins that protect neurons.

Benefits include:

• Protecting nerve cells
• Regenerating injured nerves and restores function
• Reducing pain in people with diabetic neuropathy (however, the benefits did not persist after six to 12 months)

Additional studies are necessary to understand how acetyl-L-carnitine impacts neuropathy and whether the benefit depends on the type of neuropathy. People on hemodialysis regularly supplement with acetyl-L-carnitine to help fight chronic inflammation and oxidative stress.

2. Alpha-Lipoic Acid

Alpha-lipoic acid (ALA) is an omega-3 fatty acid and antioxidant. Benefits include:

• Reduces inflammation and supports nerve blood flow and signaling.
• Decreased pain intensity and perceived pain 
• Reduces symptoms of diabetic neuropathy, specifically burning, pain, and numbness  

ALA is relatively safe and well tolerated, even when taken above the recommended dosage. However, doses greater than 1,200 mg may induce gastrointestinal side effects. ALA may be safe during pregnancy when taken orally in doses of up to 600 mg daily for up to four weeks, but it is not recommended during breastfeeding. 

Children ages 10–17 may safely take ALA orally in doses of up to 600 mg daily for three months. ALA may be unsafe for younger children, especially when administered in larger doses. 

ALA slows blood clotting when taken with blood thinners, and can decrease the effects of your thyroid medication. Similarly, ALA may lower blood sugar levels when taken with an antidiabetic (blood sugar lowering) medication. 

3. B Vitamins

B vitamins are essential for countless body reactions. B vitamin deficiencies lead to neuropathy, so getting enough B vitamins is essential to imrpove neuropathy symptoms. B vitamins seem to benefit those who have neuropathy best if they have a nutrient deficiency. Consider discussing with your healthcare provider and checking your vitamin B levels before starting a supplement.

Benefits include:

• Reduces neuropathy symptoms according to some clinical trials
• Helps produce neural membranes
• Helps with nerve function

There are eight types of B vitamins required for health. In particular, thiamine (B1), pyridoxine (B6), folate (B9), and cobalamin (B12) are linked with neuropathy. Maintaining adequate levels of these B vitamins prevents nutritional neuropathies (neuropathy caused by lack of nutrients.

Additional research is required to understand the role of B12 in neuropathy fully. Many studies do not show baseline vitamin B12 levels, so the benefit of supplementation may be due to B12 levels returning to normal.

4. Capsaicin

Capsaicin is the compound in chili peppers that makes them spicy. Capsaicin is typically applied as a cream. Over-the-counter creams containing 0.075% capsaicin or high-dose patches with 8% capsaicin are the most common and effective supplements. Creams containing less than 0.075% capsaicin are ineffective

Benefits include:

• Preventing nerves from sending pain signals
• Treating peripheral neuropathy
• Providing moderate pain relief from HIV-related or postherpetic neuropathy (a common complication of shingles)

Capsaicin causes itching, burning, or redness at the application site. But these side effects are generally short term.Avoid contact with the eyes. Do not apply capsaicin to damaged or burned skin.

Capsaicin interacts with the following medications:

• Cyclosporine: Taking capsaicin concurrently with cyclosporine limits the breakdown of cyclosporine, an immunosuppressant medication.
• Ativan (lorazepam): Capsaicin reduces the metabolism of lorazepam, a drug taken for seizures and mood disorders.

5. Cannabidiol

Cannabidiol (CBD) is a compound found in the marijuana plant. Unlike other compounds in marijuana, CBD does not cause a sense of euphoria (a “high”). CBD comes from hemp or non-hemp plants. The 2018 Agriculture Improvement Act legalized cannabidiol derived from hemp at the federal level. However, cannabidiol remains on the controlled substances list for some states. Please be mindful of your state’s laws about CBD use and avoid use if it is not legal in your area.

Benefits include:

• Reducing and blocking inflammatory markers associated with neuropathy 
• Reducing the development of neuropathic pain
• Reducing in intense, sharp, cold, and itchy pain sensations

Research on cannabidiol is new and evolving, so there is no set recommended intake. Dosage will vary depending on topical or oral CBD use. Exercise caution when consuming CBD because limited data on its safety exists. Possible side effects of CBD include the following:

CBD is not recommended during pregnancy or breastfeeding. It is unclear whether CBD passes to the baby through breast milk. More data is necessary to determine the safety associated with CBD products applied to the skin.

6. Coenzyme Q10

Coenzyme Q10 (CoQ10) plays an essential role in supporting mitochondria (the cell’s powerhouse) function through its anti-inflammatory and antioxidant properties.

Benefits include:

• Decreasing inflammatory molecule levels
• Increasing antioxidant production
• Protecting neurons from dying
• May improve pain and sleep

Side effects of CoQ10 are generally mild and include insomnia and digestive issues. Few severe side effects have been reported.

CoQ10 interacts with the following medications:

• Warfarin: CoQ10 increases the metabolism of warfarin, affecting anticoagulation. However, some research suggests that CoQ10 does not affect warfarin metabolism at daily doses of less than 100 mg. 
• Vitamin E: taking vitamin E with CoQ10 decreases the absorption of CoQ10. 

People consume an average of 3–5 mg of CoQ10 daily through the diet. Food sources of CoQ10 include chicken thighs, herring, and trout. Consult with your healthcare provider before starting CoQ10 to figure out your proper dosage.

7. Gamma-Linolenic Acid

Gamma-linolenic acid (GLA) is an omega-6 essential fatty acid. GLA can be obtained from the diet via borage, black currant oil, and evening primrose oil.

Benefits include:

• Decreasing blood pressure
• Reducing the number of pain sites
• Improving movement

Not enough data exists to support GLA supplementation during pregnancy and breastfeeding.Supplementation is not recommended if you have elevated triglycerides because omega-6 fatty acids can further raise levels.

8. Magnesium

Magnesium is a mineral involved in many bodily processes, including muscle and nerve function.

Benefits include:

• Reducing pain
• Improving movement
• Treating peripheral neuropathy caused by shingles

Causes and Symptoms of Neuropathy

Multiple types of neuropathy exist depending on the underlying health issue. Neuropathy can result from the following:

It is also possible for neuropathy to develop without a known cause.

Neuropathy symptoms vary depending on the nerves and the body area affected. Common symptoms include the following:

What Else Can You Do for Neuropathy?

Besides supplements, lifestyle modifications focusing on diet, stress, and movement alleviate neuropathic pain.

Exercise

Exercise has the potential to reduce neuropathic pain. Certain forms of exercise are more effective than others at alleviating symptoms of different neuropathies. 

Muscle strengthening and balance training alleviate chemotherapy-induced peripheral neuropathy. Moreover, some research suggests engaging in physical activity at the start of chemotherapy prevents the development of chemotherapy-induced peripheral neuropathy.  

Participating in a mix of aerobic and higher-intensity exercise may particularly benefit those with diabetic neuropathy. Exercise may also prevent the development of neuropathy because regular physical activity helps control blood sugar.

A mix of aerobic and progressive strength training enhances other treatment methods for HIV-related neuropathy. 

Mindfulness

Participating in mindfulness therapies, cognitive behavioral therapy (CBT), and pain reprocessing therapy (PRT) has reduced pain and improved the quality of life for people with different kinds of pain. Notably, mindfulness produced long-term pain relief, whereas the benefits of CBT were less apparent after treatment had ended. 

Summary

Supplements such as ALA and acetyl-L-carnitine may provide some relief from neuropathic pain. Limited data exists to support the use of other supplements, such as B vitamins, capsaicin, magnesium, GLA, and cannabidiol, for neuropathy.

However, maintaining adequate levels of B vitamins and magnesium may prevent the development of neuropathy due to nutrient deficiencies. Talk with your primary healthcare provider to review the risks and benefits of introducing supplements into your routine.