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Diabetes

How Is Diabetic Nerve Pain Treated?

Nerve pain caused by diabetes, known as diabetic peripheral neuropathy, can be severe, constant, and hard to treat. It may start as a tingling feeling, followed by numbness and pain. But there are two key points that everyone with diabetes and peripheral neuropathy should know:

  • Controlling your blood sugar can keep the pain from getting worse and improve your health.
  • Medications can help relieve nerve pain, make you more comfortable, and improve your quality of life.

Start With Blood Sugar

If you have diabetes and peripheral neuropathy, talk to your doctor about how to manage your blood sugar levels. That may mean you need to take insulin.

Once you’re doing all you can to keep your blood sugar in check -- including diet, meal planning, exercise, and medication -- ask the doctor which pain treatment could best relieve the rest of your symptoms.

There are many medications that can ease nerve pain and help you function at near-normal levels. But you may need to try several different types before you find the one that works best.

Over-the-Counter (OTC) Pain Relievers

Some people find relief right on drugstore shelves. Common pain relievers and some skin creams may help. It depends on how severe your pain is.

Talk to your doctor before taking any product. Even over-the-counter medications can interact with other drugs or cause severe side effects. Here are some options:

NSAIDs (nonsteroidal anti-inflammatory drugs) reduce inflammation and relieve pain. Those available without a prescription include aspirin, ibuprofen, and naproxen.

But NSAIDs can cause harmful side effects like stomach irritation and bleeding if you take them for a long time. They can also lead to kidney and liver damage, which may be more likely in people with diabetes. But the risk is low.

Acetaminophenand other over-the-counter drugs that contain it relieve pain without reducing inflammation. These medications don’t cause the stomach irritation that NSAIDs do, but taking more than recommended can lead to liver damage. Read labels and check with your pharmacist.

Capsaicinis found naturally in chili peppers. It’s thought to control a chemical called substance P, which helps send pain signals through your nerves. It can help in the short term, but there are concerns about long-term use. That’s because these same nerves play a role in wound healing, a process that’s already a problem if you have diabetes.

Lidocaineis an anesthetic that numbs the area it’s applied to. It’s available in gels and creams, both over the counter and by prescription.

Other topical creams. Salicylate is a chemical similar to aspirin. It's found in pain-relieving creams. Cortisone products contain corticosteroids, which are potent anti-inflammatory drugs that can help ease pain. Both are available at drug stores, but there’s no clear evidence that they help relieve nerve pain from peripheral neuropathy.

Prescription Drugs

Many people need to turn to prescription medication to find relief.

NSAIDs are also available by prescription. They may be different doses or different drugs altogether from what’s offered without a prescription.The side effects -- stomach trouble and greater chances of heart disease -- are the same as with other forms.

Antidepressants treat depression but have also become important in relieving chronic pain. They can work whether you're depressed or not. Those used to treat pain include:

  • Tricyclic antidepressants, which affect the levels of the brain chemicals norepinephrine and serotonin. Experts say they’re the most effective of the antidepressants used for pain. But they also cause side effects, like drowsiness, weight gain, dry mouth, and dry eyes. Blood pressure, heart rate problems, and dizziness can also happen with these drugs.
  • Selective serotonin reuptake inhibitors (SSRIs), which work by altering the amount of the brain chemical serotonin. They’re effective for depression but less helpful for pain.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), which treat depression by boosting the brain chemicals serotonin and norepinephrine. They may have fewer side effects than the SSRIs or TCAs.

Antiseizure drugs, used to prevent epileptic seizures, can also relieve neuropathy. The drugs control the nerve cells in the brain and other parts of your body, such as legs and arms, that transmit pain. But they can make you dizzy or sleepy, especially at high doses.

Opioid medicines. When your problem is severe, you want immediate relief. That's when you should see a pain specialist. You might need strong medicines that contain a weak opioid (a morphine-like substance). These drugs also affect the brain chemicals serotonin and norepinephrine, similar to antidepressants, and reduce your feeling of pain.

Opioids can provide a better solution for "breakthrough pain" -- a kind that suddenly worsens for no apparent reason -- than OTC drugs.

Neuropathy specialists shy away from strong narcotic opioid medications. They can cause severe constipation, and there’s a chance you could get addicted. There's also a stigma connected with using this type of drug. And depending on the type of work you do, it could be a problem.

More Treatment Options

Injections of local anesthetics like lidocaine -- or patches that contain it -- can also numb the area.

Doctors could also:

  • Surgically destroy nerves or relieve a nerve compression that causes pain
  • Implant a device that relieves pain
  • Perform electrical nerve stimulation which may relieve pain. In this treatment, small amounts of electricity are used to block pain signals as they pass through the skin. Experts say its effectiveness is debatable.

Other useful aides to improve your quality of life include:

  • Hand or foot braces that can help muscle weakness or relieve nerve compression
  • Orthopaedic shoes that can improve walking problems, which will prevent foot injuries

WebMD Medical Reference

Reviewed by Michael Dansinger, MD on June 25, 2013

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