The Doctor-Approved Guide to Diabetic Neuropathy Treatments

Preventing diabetic nerve pain

Start with this blood sugar level guide to help manage your diabetes, because the adage that an ounce of prevention is worth a pound of cure rings true when it comes to diabetic neuropathy, says Caroline Messer, MD, an endocrinologist at Lenox Hill Hospital in New York City. High blood sugar increases the risk of all diabetes side effects including painful nerve damage, and that’s what leads to diabetic neuropathy treatment. “Keeping blood sugar—glucose—under tight control can help stave off nerve damage and pain,” she says. This means eating a careful diet, regular monitoring plus medications. “We can treat blood sugar with insulin or add on new classes of blood sugar-lowering drugs to bring glucose down to where it should be.” Preventing the condition requires the same lifestyle changes that you’d make for diabetes in general, including quitting smoking and keeping weight in the normal range, adds Gary W. Jay, MD, a clinical professor of neurology at the University of North Carolina at Chapel Hill. “Once you develop the pain, however, it’s not going to get better without treatment.”

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Tatiana Ayazo/RD.comDiagnosing diabetic nerve pain

What is diabetic neuropathy? The first symptom tends to be numbness and pain in your hands and feet, and this pain feels and acts differently than other types of pain. “It feels like burning electrical impulses are shooting through your feet and legs, and it is often symmetrical,” Dr. Messer says. Some people report numbness or pins and needles, she says. It also tends to occur at rest not during activity. By contrast, peripheral artery disease (PAD)—which also travels with diabetes—is worse with activity. “Establishing the proper diagnosis will help determine the best course of treatment for diabetic neuropathy,” she says. Your doctor will take a thorough history, conduct a physical exam and possibly order nerve conduction studies or perform other tests to see how well your nerves function, she explains. Don’t miss these key facts about diabetic neuropathy.

Anti-seizure drugs

The newest guidelines from the American Diabetes Association recommend the anti-seizure drug pregabalin (Lyrica) as one of the first-line diabetic neuropathy treatments. Exactly how anti-seizure medications soothe nerve pain is not 100 percent understood, but they may interfere with the overactive transmission of pain signals sent from damaged nerves. Lyrica is not the only anti-seizure drug available, but it is the only one that is specifically approved by the U.S. Food and Drug Administration (FDA) for diabetic nerve pain. “Lyrica has been better studied specifically for diabetic nerve pain whereas gabapentin [another anti-seizure medication] has been studied in neuropathy in general,” Dr. Jay says. Lyrica does come with a much higher price tag, which is why other anticonvulsants such as gabapentin (Neurotin) may be tried. There may also be some natural remedies worth trying for diabetic nerve pain.

Antidepressants

Antidepressants may reduce nerve pain in addition to the depression that tends to travel with the pain. Sometimes individuals will need more than one diabetic neuropathy treatment to get ahead of the burning and numbness. “Once you are on a therapeutic level of one drug such as Lyrica, it can take as long as eight weeks to see how well it is working,” Dr. Jay says. “If the pain was a 7 out of 10 and then it is a 4 or 5 after six weeks on the drug, it may be enough for some people, but others may need more relief.” In these cases, Dr. Jay would add Cymbalta (duloxetine), an antidepressant that is specifically approved for diabetic nerve pain. The ADA guidelines back up this approach, and suggest that Cymbalta can also be a first-line therapy for diabetic nerve pain. “I add some Cymbalta and, if the patient can tolerate it and isn’t having any side effects, we titrate them to the right dose,” he says. Some people may develop stronger side effects than others with Cymbalta, such as dry mouth, constipation, and nausea. If the side effects are troublesome, other options include tricyclic antidepressants: While not specifically approved for diabetic nerve pain, this older class of drugs may offer some benefit. But they have their own share of side effects, including excessive sleepiness. The good news? Scientists may be on the road to making antidepressants work faster.

Pain killers

Sometimes two diabetic neuropathy treatments—an anticonvulsant and an antidepressant—are not enough, Dr Jay says. “Let’s say that after a month or six weeks, pain is now a 4, but the individual wants to go back to work quickly. In these cases, I would consider adding an opioid,” he says. “These are always the third choice.” Opioids do confer a fair share of risks including addiction, so they are prescribed with caution. The ADA guidelines are in line with this approach and suggest that opioids only be used if all other medications fail to adequately treat symptoms. Here’s what you need to know about opioids and the management of chronic pain.

Lidocaine

There are other options to consider for this condition, says Dr. Messer. Topical lidocaine—whether in patch, gel or spray form—may serve as a diabetic neuropathy treatment. “Patches can’t be placed on the feet and hands, but this is an OK approach for nerve pain in the legs and arms.” Lidocaine is topical, not oral, so the risks are much lower. Do you know the top 10 silent signs of diabetes?

Capsaicin

Capsaicin—the ingredient that gives chili peppers their kick—may help dial down diabetic nerve pain by numbing the area. Over-the- counter strengths may not always do the trick, but higher doses can cause an initial burn. “You can go in to your doctor’s office and get slathered with lidocaine to numb the area and then he or she will apply high dose capsaicin, Dr. Jay says, adding that “it’s a real production.” (Hot peppers may help us live longer, too.)

Antioxidants

Antioxidants such as alpha lipoic acid or ALA may also help treat diabetic nerve pain, Dr. Messer says. Research suggests that ALA may work more quickly than other treatments and improve numbness, sensory deficits, and muscle strength in addition to easing pain. And it can do all this minus the side effects associated with other diabetic nerve pain therapies. “ALA may be chosen in patients with early neuropathic deficits and symptoms, in whom clinical improvement is more likely,” the study authors write.

Good foot hygiene

When you have diabetic nerve pain, the numbness in your feet can lead to infection or worse, Dr. Messer says. So make sure you understand proper diabetic foot care. “You lose sensation, and, because of this, you are much more likely to get a wound, and we know wounds heal slowly,” she says. “Check your feet for cracks, fissures, and calluses. If you catch them early, you can fix them using special shoes or creams to prevent progression.” Here’s some of the best footwear for people with neuropathy.

Vitamin D

Is there nothing vitamin D can’t do? Also known as the sunshine vitamin because our bodies produce it when exposed to sunlight, vitamin D may also help improve diabetic nerve pain. Studies have shown that many people with diabetic nerve pain are vitamin D deficient. Take a look at this to figure out if you need to get vitamin D levels tested. In a study, researchers gave people with diabetic nerve pain and low vitamin D levels a single shot of D (600,000 IU) under the skin at the first visit, and they found that 10 weeks later, the volunteers had much less diabetic neuropathy pain. The benefits peak at 10 weeks and last as long as 20 weeks, the study showed.

Botox

Yes, Botox, that very same wrinkle-reducing neuromodulator, may also help relieve diabetic nerve pain. It’s well-known that botulinum toxin causes temporary muscle paralysis (thus the wrinkle-deleting effects), and any pain-reducing effects have been attributed to this very effect. New research suggests it may quell nerve pain too. Curious about this treatment? Here are 11 things you need to know about Botox.