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Diabetes

Treatment for Diabetes Nerve Pain

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

  • Controlling your blood sugar levels can help prevent worsening nerve pain and improve your overall health at the same time.
  • Medications can help relieve nerve pain, make you more comfortable, and improve your quality of life.

The single most important factor in preventing neuropathy, slowing its progress once you have it, and relieving many symptoms, is better glucose control, experts say.

If you have diabetes and peripheral neuropathy, talk to your doctor about ways to better control your blood sugar, including the possibility you may need to take insulin for better control.

Once you are doing all that you can to keep blood sugar levels under control -- including diet, meal planning, exercise, and medication -- you should assess with your doctor which pain medication is best to relieve your remaining symptoms.

Fortunately, medications can help relieve nerve pain from peripheral neuropathy so you can function at near-normal levels. You have many pain relief drugs from which to choose. But you may need to try several different types of pain relievers before you find the one that helps you.

Over-the-Counter Pain Relievers for Diabetes Nerve Pain

Some people find relief for mild diabetes nerve pain right on their drug store shelves. Common pain relievers and some topical creams may help, depending on the severity of pain.

Anyone with diabetes should talk to his or her doctor before taking any medication. Even over-the-counter medications can interact with other drugs or cause severe side effects in people with diabetes.

Here are some over-the-counter pain relief options to consider:

NSAIDs (nonsteroidal anti-inflammatory drugs). These medicines reduce inflammation and relieve pain. NSAIDs available without a prescription include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).

But NSAIDs can cause harmful side effects such as stomach irritation and bleeding in some people if taken for weeks or months. When taken long-term they can also lead to kidney and liver damage, which may be more likely in people with diabetes.

However, the risk is low.

Acetaminophe n.Acetaminophen and other over-the-counter drugs containing acetaminophen relieve diabetes nerve pain without reducing inflammation. These medications do not cause the stomach irritation that NSAIDs do. However, taking more acetaminophen than recommended can lead to liver damage. It is important to read labels and check with your pharmacist.

Capsaicin. Found naturally in chili peppers, capsaicin is found in drug stores under various brand names, including Capzasin-P and Zostrix.

Capsaicin is thought to ease pain by reducing a chemical called substance P, which is involved in transmitting pain signals through the nerves. On a short-term basis, it is an effective approach. But there are concerns about the long-term consequences. These same nerves play a role in wound healing, and there is concern that capsaicin could prevent wound healing, which is already a big problem if you have diabetes.

Lidocaine. Lidocaine is an anesthetic that numbs the area it has been applied to. It is available in gels and creams, both over the counter and by prescription. Some product names include Topicaine and Xylocaine.

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

Prescription Drugs for Diabetes Nerve Pain

Many people need to turn to prescription medication to find relief for diabetes nerve pain. Your choices include:

NSAIDs. Although some nonsteroidal anti-inflammatory drugs are available over the counter, your doctor may suggest higher doses, or different NSAIDs, that require a prescription. There are many prescription NSAIDs to choose from including, Celebrex, Lodine, and Relafen. People with diabetes are more at risk of kidney damage that can occur with NSAIDs. In addition, people with diabetes are at high risk of heart disease, and prescription NSAIDs may raise the risk of heart problems.

Antidepressants. Although antidepressants were developed for depression, these drugs have also become important in relieving chronic pain - whether the person is depressed or not. Antidepressants used to treat pain include:

  • Tricyclic antidepressants (TCAs) primarily affect the levels of the brain chemicals norepinephrine and serotonin. TCAs are the most commonly used antidepressant and, according to experts, the best studied, and the most effective of the antidepressants used for pain.

Of the TCAs, Elavil has been a very good option for pain, yet it has troublesome side effects, including drowsiness, weight gain, dry mouth, and dry eyes. For people with peripheral neuropathy, there can be additional side effects. Many people also develop blood pressure and heart rate problems and get dizziness when taking Elavil.

A newer drug in this class, Pamelor, is effective and has fewer side effects, so it is better tolerated. Norpramin is also considered good and has the least side effects of all.

  • Selective serotonin reuptake inhibitors (SSRIs) are a newer form of antidepressant. These drugs work by altering the amount of the brain chemical serotonin. SSRIs are very effective for depression, the experts say, but less effective for pain. Some studies have shown them to be beneficial, but they're still less effective than TCAs for pain.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.

    Effexor and Cymbalta are quite effective for pain and have fewer side effects than the SSRIs or TCAs. Cymbalta is FDA-approved for painful neuropathy; Effexor is not.

Antiseizure drugs. Drugs that prevent epileptic seizures can also relieve certain pain conditions, including neuropathy. The drugs work by controlling the abnormal firing of nerve cells in the brain and other parts of the body, such as legs and arms.

  • Neurontin is the antiseizure drug most commonly used for nerve pain from peripheral neuropathy. While it's effective at treating painful neuropathy, it tend to cause sedation or dizziness at higher doses. But if the dosage is increased slowly, it is well tolerated.
  • Lyrica is a seizure medication that is FDA-approved for painful neuropathy. The most common side effects are dizziness and sleepiness.

Opioid medicines. When pain is very severe, people want immediate relief. That's when you may need to see a pain specialist. Sometimes people need strong painkillers called Ultram or Ultracet, possibly in combination with Neurontin. The combination gets people past that acute stage of pain.

Both Ultram and Ultracet are FDA-approved painkillers that contain tramadol, a weak opioid (morphine-like) substance. The drug also weakly affects the brain chemicals serotonin and norepinephrine, similar to antidepressants, which reduces the perception of pain.

Tramadol is often used as a back-up for what's called "breakthrough pain" -- pain that suddenly, for no apparent reason, is worse. Tramadol is a good replacement for over-the-counter medications at those times.

Neuropathy specialists shy away from strong narcotic opioid medications. Narcotics can cause severe constipation, and there is the potential for addiction. There's also a stigma connected with using a narcotic drug, and depending on the type of work a person does, it could be a problem.

More Treatment Options for Diabetes Nerve Pain

For severe, intractable diabetes nerve pain, injections of local anesthetics such as lidocaine - or patches containing lidocaine - are used to numb the painful area.

Doctors can 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 quality of life and function include:

  • Hand or foot braces that can compensate for muscle weakness or help relieve nerve compression.
  • Orthopaedic shoes that can improve gait (walking) problems, which will prevent foot injuries.

WebMD Medical Reference

Reviewed by Michael Dansinger, MD on June 25, 2013

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