Treatments for Peripheral Neuropathy Pain Caused by Diabetes

Medications, Topical Treatments, and Alternative Options

Oxycodone pills used for pain management.
Oxycodone pills used for pain management. GIPhotoStock/Getty Images

Neuropathy (or nerve damage), is a long-term complication of diabetes that typically takes many years to develop. Peripheral neuropathy occurs when the nerves stop signaling or they signal too much in the wrong direction. This can be experienced as a result of prolonged exposure to elevated blood glucose levels and affects the nerves of the extremities, most commonly the feet, hands, and lower legs.

The longer a person has diabetes, the greater the risk of developing neuropathy, especially if blood sugars remain elevated. Symptoms vary from person to person, but include numbness, tingling, or prickly feelings. As it advances, some people may experience intense burning or stabbing pain. Oftentimes, painful diabetic neuropathy occurs after some rapid change in a persons blood sugars, for example, during times of ketoacidosis and weight loss. In these instances, painful neuropathy may spontaneously resolve within several months. If you are in pain, there are certain measures you can take to ease your pain and prevent or delay further damage. 

How Can You Improve Neuropathy?

Getting your blood sugars stabilized is an important step in potentially controlling pain and preventing further damage. Keeping your blood sugars on target can help to improve circulation and prevent or delay further nerve damage.

Monitoring your blood sugars, eating a diet that is modified in carbohydrates, exercise, and taking your medicines as prescribed are initial steps that can be taken to stabilize your blood sugars. If you are not sure why your blood sugars are elevated, contact your health care team. You may need to update your treatment plan and consulting with the experts, such as a certified diabetes educator, is a great way to get you on track.

  

Supplements

There is a strong body of research that suggests, alpha-lipoic acid to be a good treatment option for those people with neuropathy. Alpha-lipoic acid is an antioxidant that can help to attack free radicals which can cause damage to organs, cells, and tissues. Research has demonstrated that supplementing with alpha-lipoic acid, both orally and intravenously may help to relieve pain associated with diabetic neuropathy. Ask your health care provider before starting any supplements, as alpha lipoic acid can lower blood sugars. In the mean time, adding foods such as broccoli and spinach into your diet can increase your intake of natural alpha-lipoic acid.

Medication Options

The most effective pain relief treatments appear to be the antidepressants (TCAs and SSRIs) and the anticonvulsants. 

Tricyclic Antidepressants (TCAs)

  • TCAs can be effective at treating neuropathic pain. Although they are classified as antidepressants, their pain relieving properties can typically be felt at much lower doses than what is prescribed to a person with depression.
  • Common TCAs prescribed for neuropathy include: Imipramine (Tofranil), amitriptyline (Elavil), and nortriptyline (Pamelor, Aventyl). Elavil is currently the most commonly prescribed antidepressant medication prescribed for peripheral neuropathy.

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • SSRIs are another class of antidepressant that also treat anxiety. They work like TCAs, in that at lower doses, they are effective for neuropathic pain. They seem to be better tolerated and the side effects are generally fewer than TCAs, but the downside is that sometimes they are not as effective.
    • Cymbalta (duloxetine hcl) is both a serotonin and norepinephrine reuptake inhibitor, which scientists feel offers better pain control. Other single-action SSRIs include citalopram (Celexa), escitalopram oxalate (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

      Anticonvulsants

      • These medications work by stabilizing damaged nerves and easing the pain signals that they send to the brain. Popular anticonvulsants that are approved for diabetic peripheral neuropathy include: gabapentin (Neurontin) and pregabalin (Lyrica)

      Topical Treatments

      Topical treatments, such as cream, sprays and patches can also be reasonably effective. These include capsaicin cream, lidocaine patch, and isosorbide dinitrate spray.

      Trancutaneous Electrical Nerve Stimulation

      Trancutaneous electrical nerve stimulation is a therapy that uses a low-voltage electrical current for pain relief. A pulse of electricity is sent through the skin to stimulate the nerve. The thinking is that when the electrodes stimulate the nerves, a signal is sent to the brain that blocks pain signals. Or the lack of perceived pain maybe due to stimulation of endorphins, which can block pain. This type of treatment has not been proven to eliminate pain, but some people who have used it, report feeling better afterwards. 

      Acupuncture

      Originating in Ancient China, acupuncture has been used for thousands of years as a remedy for pain. It involves the insertion of needles to stimulate nerve impulses which is thought to help relieve pain. Some people with peripheral neuropathy report this works. 

      What About Narcotics/Opioids?

      Many doctors and patients are concerned about the stigma of addiction and only consider opioids as a pain control option when nothing else has worked. If you have tried everything without relief you may be able to discuss this option with your physician. 

      A Word From Verywell

      Finding pain relief for diabetic peripheral neuropathy can be challenging because there is no specific drug or treatment regimen that works for all people. Very often, a patient and doctor must try many different kinds and combinations of interventions until acceptable pain relief is reached. However, it's important to note that keeping your blood glucose levels within your target range remains a key goal in managing peripheral neuropathy. 

      Sources:

      Curry, Andrew. Treating Nerve Pain. Diabetes Forecast. Peripheral Neuropathy. 

      Mijnhout GS, Alkhalaf A, Kleefstra N, Bilo HJ. Alpha lipoic acid: a new treatment for neuropathic pain in patients with diabetes? Neth J Med. 2010 Apr;68(4):158-62.

      Ziegler, D. Oral treatment with α-lipoic scid improves symptomatic diabetic polyneuropathy. Diabetes Care 2006 Nov; 29(11): 2365-2370. 

      Ragothaman, K and Shofler, D. The emerging role of alpha-lipoic acid for diabetic neuropathy. Podiatry Today 2015. Jul; 28(7): 18-22. 

       

      Continue Reading