Diabetic neuropathy is present in more than half the cases and is painful in one-fourth of people living with diabetes. Treatment of diabetic neuropathy should be a mix of modern medications and traditional therapies. Each method has its specific benefits and disadvantages. Natural remedies and traditional methods can be useful in preventing progression and in some cases may even reverse the diabetic neuropathy.
Medications to treat diabetic nerve pain are primarily aimed at relieving the symptoms. They belong to the class of drugs used to treat seizures, depression, and opioid painkillers. Most of the medications prescribed in diabetic neuropathy cannot alter the course of the disease. Hence, strict control of blood glucose remains the mainstay of treatment and prevention of neuropathies.
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This type of drugs remains the treatment of choice, they are recommended as the first line treatment by various professional organizations like American Diabetes Association. One of the most common medications that are prescribed to treat diabetic nerve pain is pregabalin. Pregabalin can provide consistent pain relief, improve quality of sleep. It is generally given at the dose of 300-600 mg daily in two divided doses. Another similar drug gabapentin may also help with nerve pain.
Other anti-seizure drugs like oxcarbazepine, lamotrigine, and lacosamide have not shown to be beneficial in nerve pain and are rarely used. It is also important to know that these drugs may have side effects and are not recommended during pregnancy. Dizziness, headache, weight gain, and drowsiness are most commonly reported side effects of these drugs.
It is a vast family of drugs, which are proven to be clinically useful for pain relief. Amitriptyline is perhaps the most studied drug from this group. It has been shown to be beneficial in the majority of the cases, though side effects are common with one-third of cases unable to continue this drug in the long term.
Serotonin-norepinephrine reuptake inhibitor (SNRI) drug called Duloxetine was one of the first drugs to get approval from FDA for the treatment of nerve pain related to diabetes, while it is less efficient than amitriptyline but is known to cause fewer side effects.
Desipramine, imipramine, or fluoxetine are other drugs that may be recommended in some cases.
These are powerful painkillers, but they are not meant for long-term usage. Moreover, their effectiveness may decline if taken over a more extended period. In cases, when other drugs fail to relieve pain, opioids remain the drugs of choice. One of the most commonly used opioid-like medication that is prescribed in nerve pain is tramadol. As with any opioids, it may cause side effects of constipation, nausea, and dizziness. Opiates are known to cause addiction due to their impact on other brain centers.
They are applied locally on the skin at the painful location; they may be given at any time of the therapy. Due to their application on the surface, they have fewer side effects, but at the same time, they would be less effective in pain relief. The commonly prescribed topical medications are as follows.
Capsaicin (e.g. Earth’s Care Arthritis Cream or Salonpas HOT Capsicum Patch) has been shown to benefit from nerve pain caused due to diabetes significantly. In some people it may cause burning sensation, else side effects are rare.
Lidocaine (e.g. Scar Zone Burn Gel or Aspercreme Max Strength Pain Relieving Lidocaine Patch) is a potent local anesthetic that relieves pain instantly; it is comparable to many oral medications but with fewer side effects.
Isosorbide dinitrate spray (ask your doctor) is a vasodilator and muscle relaxant (e.g. MRM Relax-All), it improves the blood flow towards sensitive nerves, and decreases the sensation of pain.
Benfotiamine (e.g. Doctor’s Best Benfotiamine) a derivative of vitamin B1 has been found to be beneficial in painful neuropathy related to diabetes. However, its long-term effectiveness is not known but may be useful when used with other drugs. Being a derivative of vitamin B1 means that there are no side effects of this medicine.
Alpha lipoic acid (e.g. Doctor’s Best Alpha-Lipoic Acid) is perhaps one of the most studied antioxidant substance for neuropathic pain. Clinical studies have demonstrated that alpha lipoic acid 600 mg given intravenous for three weeks may help to decrease the feeling of nerve pain for up to one year. However, the effectiveness of an oral form of alpha lipoic acid is doubtful.
Nerve pain is a long-lasting problem for many people who have diabetes; it is difficult to reverse, though timely treatment may inhibit its progression. Many medications are used for pain relief; they are not equally effective in all the people. When choosing any of the medicines for nerve pain, it is essential to understand that they have many side effects. And finally, it must be understood that there is no quick fix formula for diabetic neuropathy, and any kind of medicine would need time to work. Many of these medications would also require the dose adjustments before the optimal effect is felt.