Q. I have nerve damage of my middle back. It causes constant burning and throbbing and makes my legs feel very weak. I find the pain unbearable. TENS and acupuncture haven't helped. Osteopathy seems to aggravate the pain. Anything touching the area brings on a flare up. In the past I've tried various pain killers - Codydramol, Co-proxamol, Mepid, Acupan and Baclofen. I now take Zydol and Amitriptyline which offer some relief. Are there any new pain killers in the pipeline which might help the burning and throbbing?

A. I assume that you have already seen the appropriate specialists and that any need for surgery or treatable causes of your pain have been ruled out. This needs to be done if it is not already.

You describe neuropathic pain - pain which can occur after nerve damage. This type of pain can be very difficult to treat, but may get better with time. Most of the usual pain killing drugs have little or no effect on neuropathic pain. There are, however, a variety of other drugs that can be tried, but there is no guarantee that they will work. These drugs were designed in the first place to treat other medical conditions such as epilepsy or depression, but it has been found that they can help neuropathic pain. They only work for a third or a quarter of patients who use them. Sometimes it is a case of trying several different drugs until you find one that works for you. Unfortunately all these drugs have side effects and risks which must be balanced against the potential benefits that they might bring. These side effects are different from drug to drug and your doctor will be able to advise you more specifically. The other problem is that many of these drugs take a few weeks to become effective, so the process of finding one to suit you can be long and exasperating. Occasionally it is possible for the doctor to try injecting some of these drugs directly into the vein to see if they work. Amitriptyline is an example of one of these types of drugs, but other examples include: sodium valproate, clonazepam, carbamazepine, gabapentin and mexillitine. New drugs, which are potentially useful in neuropathic pain, are at an experimental stage, but it will take a number of years before they have passed the stringent safety controls necessary to be prescribed to the public.