Diabetic Neuropathy Treatment Options

• Blood Pressure Control – Uncontrolled blood pressure puts you at higher risk of diabetes complications. Make your blood pressure a priority, and do what you can to keep it in a healthy range as recommended by your doctor.
• Physical Activity – Being physically active every day is an important part of managing diabetes and its complications. Exercise can help lower blood sugar, improve blood flow, and provide several other health benefits. If you suffer from complicated diabetes, it’s recommended to exercise a significant part of your day, spending around 2.5 hours doing moderate aerobic activity or 1.25 hours of vigorous aerobic activity every day. A doctor or physical therapist can help you determine an appropriate exercise regimen.
• Maintain a Healthy Weight – Obesity can make diabetes complications much more difficult to live with. It follows that healthy food choices are another important part of diabetes and pain management. If you’re trying to fight back against diabetes, vegetables, fruits, and whole grains should make up a larger portion of your diet, and you should proactively limit portion sizes to maintain a healthy weight.
• Stop Smoking – Smoking and other tobacco products adversely affect circulation and healing, and can therefore prevent other therapies from work effectively. If you smoke, now is the time to quit.
• Physical Therapy – A physical therapist can help identify highly effective exercises that are low-impact and easily tolerated, such as swimming. Some physical therapists specialize in diabetes complications and/or neuropathy, and can help you overcome diabetic neuropathy complications that would otherwise affect your ability to exercise.

• Routinely check your feet for sores, bruises, cuts, swelling, infections, and other problems, even if you don’t feel any pain.
• Wash your feet daily with warm water, and make sure to dry them completely afterward. Apply a lotion after washing and drying to keep them moisturized. Avoid getting lotion in between your toes.
• Always cover your feet with thick socks, shoes, or slippers to cushion them and prevent injuries.
• Wear comfortable, flexible shoes that give your feet room to move. Break in new shoes slowly so that they don’t hurt your feet. Ask your doctor about customized shoes (orthopedic shoes) if regular shoes don’t fit well.
• Seek specialized care if you have a sore that does not heal, as it may indicate a vascular problem or another complication.

Over-the-counter and prescription pain medications may help relieve diabetic neuropathy pain. The most common are covered below.

Even though over-the-counter drugs can be obtained without the oversight of a physician, we recommend consulting with your doctor before relying on anything new to manage your diabetic neuropathy.

• NSAIDs – Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen can help reduce inflammation and relieve pain. However, NSAIDs do increase the risk of heart attack, stroke, stomach irritation, and worsening kidney damage if taken in high doses or for an extended duration, and individuals with diabetes are already at a heightened risk of these complications.
• Acetaminophen – Acetaminophen can relieve pain without reducing inflammation. This medication can lead to liver damage if you take more than the recommended dose.
• Capsaicin – Capsaicin is found in topical medications that can be rubbed on painful areas, disrupting the nerves that send pain signals to the brain. It can provide pain relief in the short term, but it is unknown whether or not long-term use can cause other complications.
• Lidocaine – Lidocaine is a numbing agent (an anesthetic). It is available in gels and creams.

• Anti-seizure drugs – Pregabalin (Lyrica) and Gabapentin (Gralise, Neurontin) are anti-seizure (epilepsy) drugs that are also prescribed to relieve nerve pain.
• Tricyclic Antidepressants – Amitriptyline, nortriptyline (Pamelor), and desipramine (Norpramin) are tricyclic antidepressants that may help with mild to moderate nerve pain.
• SNRI Antidepressants – Duloxetine (Cymbalta) and Venlafaxine (Effexor XR) are serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants that can help with nerve pain.
• Lidocaine Patches – In addition to over-the-counter medications, lidocaine may also be prescribed in prescription-strength patches that are placed on the skin to manage localized pain.
• Local Anesthetic Injections – Anesthetic injections may be prescribed to manage localized pain.
• Capsaicin Patches – Prescription-strength capsaicin patches (Qutenza) are another method of localized neuropathic pain relief.

Some healthcare providers recommend alternative therapies if other methods of pain control are ineffective. Alternative pain therapies for diabetic neuropathy include supplements, external electrical nerve stimulation, and acupuncture, among others. Alternative therapies are largely unproven, and results vary from person to person.

• Supplements – Alpha-lipoic acid and acetyl-L-carnitine may help relieve nerve pain.
• Transcutaneous Electrical Nerve Stimulation (TENS) – TENS is a therapy in which tiny electric impulses are delivered to the surface of the skin to disrupt pain signaling.
• Acupuncture – Acupuncture may help relieve diabetic neuropathy pain, but you may require multiple sessions to experience a benefit.

A spinal cord stimulator is an implantable medical device that is used to treat painful diabetic neuropathy. A spinal cord stimulator works by creating an electric field near the nerves along the spine. This electric field interferes with the electrical activity of the nerves that are involved with pain signaling to the brain. When the spinal cord stimulator is active, painful sensations are replaced with a mild tingling sensation. An important advantage of a spinal cord stimulator is that it can be personalized to your pain patterns and sensory preferences.