Current & Future Treatment Options for Painful Diabetic Neuropathy

Diabetic neuropathy is defined as unilateral or bilateral nerve damage. Diabetic patients experience bilateral nerve damage most often, with sensations of burning, numbness, tingling and cramping in the hands and feet. A combination of therapies are currently available, both pharmacologic and nonpharmacologic, to treat symptoms and boost nerve function.

• Pain medications are a part of the treatment for painful diabetic neuropathy.

Blood Glucose Management

• Keeping blood sugar readings in control is the most effective means of prevention and treatment for symptoms of diabetic neuropathy. Maintaining a healthy lifestyle, carbohydrate and calorie counting, and regular exercise help contribute to effective glucose management, with no adverse side effects. Hypoglycemic episodes are always possible with tight blood sugar control and must be addressed immediately.

Analgesics and Topical Applications

• For mild to moderate pain, analgesic products such as ibuprofen and naproxen (NSAIDs) can be purchased over the counter, while narcotic products like oxycodone and tramadol require a prescription. Long term use of NSAIDs can inhibit renal function and create gastrointestinal problems. Using narcotics causes sedation and dizziness, creating a falling risk. Constipation is also a side effect of narcotic use. Topical applications include capsaicin creams and lidocaine patches, with redness at the site the only reported side effect.

Anticonvulsants

• Effective mild to moderate pain relief has also occurred using anti-seizure medications like Neurontin, Lyrica, and Tegretol. Side effects of these medications include headache, sleepiness, dizziness and light-headedness.

Antidepressants

• Tricyclic antidepressants like amitriptyline, Pamelor, Norpramin, and Tofranil are available for symptoms of mild to moderate pain, but with numerous side effects. Paxil and Prozac, selective serotonin reuptake inhibitors (SSRIs), offer fewer side effects and less pain relief. However, a newer class of antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), is available that offers effective pain relief with minimal side effects.

Nonpharmacologic

• Several options are available using nonpharmacologic therapies with no reported adverse side effects. According to Modern Medicine, 80 percent of patients treated with transcutaneous electrical nerve stimulation (TENS) had reduced symptoms of pain. Significant pain reduction was also reported in studies using percutaneous electrical nerve stimulation (PENS) and spinal cord stimulation. Other successful nonpharmacologic treatments including biofeedback, acupuncture, hypnosis and relaxation techniques.

Future Treatments

• With ongoing research into painful diabetic neuropathy, advancements in treatment therapies are beginning to show promise. Studies show an intravenous form of alpha-lipoic acid (ALA) is effective at pain reduction as well as isosorbide dinitrate spray. Neither drug is presently available in the forms used in the study, but with continued research and successful testing, these drugs, and quite possibly others, will become available for relieving the symptoms of painful diabetic neuropathy.