Nerve pain that results from diabetic peripheral neuropathy can be very severe, continuous, and not easy to treat. It may begin as a tingling sensation, nut later numbness and pain occur. However, there are two crucial points that everybody who suffers from diabetes and peripheral neuropathy should be aware of:
* Controlling the levels of sugar in your blood can be helpful in preventing nerve pain to get worse. It may also help improve your general condition at the same time.
* Medicines can help alleviate nerve pain, make you feel more comfortably, and improve your quality of life.
"We are aware that better glucose control is the single most significant factor" in preventing neuropathy, slowing its progress once you have it, and alleviating the majority of symptoms, claims Christopher Gibbons, MD, director of the Neuropathy Clinic at the Joslin Diabetes Center in Boston and instructor of neurology at Harvard Medical School.
If you suffer from diabetes and peripheral neuropathy, consult your healthcare provider about ways to better control your sugar level in blood. According to Gibbons, you may have to take insulin for better control.
If you are doing as much as possible to keep blood sugar levels under control - including diet, meal planning, physical activity, and medicines - you should evaluate with your physician which pain drug is best to alleviate your remaining symptoms.
Happily, there are medicines that can help alleviate nerve pain from peripheral neuropathy, therefore you can function at near-normal levels. You have a lot of pain relief medications available, so you are free to pick the best for you. But you may have to try various types of pain relievers before you discover the one that helps you.
Over-the-Counter Pain Relievers for Peripheral Neuropathy
There are some people who find relief for mild nerve pain right on their drug store shelves. Common pain relievers and some topical creams may be effective, depending on the severity of pain.
Gibbons stated: "As a first line of treatment, these can be very helpful".
Everybody who suffers from diabetes should consult his/her physician before taking any medicine. Even over-the-counter drugs can interact with other medications or lead to severe side effects in patients with diabetes.
Here are some over-the-counter pain relief options to consider:
NSAIDs (nonsteroidal anti-inflammatory medications). These medications decrease inflammation and alleviate pain. NSAIDs that are available without a prescription include: aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).
However, NSAIDs can lead to harmful side effects that include: stomach irritation and bleeding in some patients if taken for weeks or months. When NSAIDs are taken for a long time they can also result in kidney and liver damage, which may be more probable in people suffering from diabetes.
However, Gibbons claims: "In many cases, particularly with younger people who are relatively healthy, the risk is quite low."
Acetaminophen. Tylenol and other over-the-counter pain relievers that contain acetaminophen alleviate pain without decreasing inflammation. These medications do not result in the stomach irritation that NSAIDs do. However, taking more acetaminophen than suggested by the specialists can bring about liver damage. It is essential for the patients to read labels and check with your pharmacist.
Capsaicin. It is found naturally in chili peppers, capsaicin is found in drug stores under different brand names, such as Capzasin-P and Zostrix. "Capsaicin has proven to alleviate pain, but there is some concern," Gibbons told WebMD. "It may not be the best approach."
Capsaicin is believed to relieve pain by decreasing a chemical substance known as P, which is involved in transmitting pain signals through the nerves. According to Gibbons, it is an effective approach on a short-term basis.
"But we are worried about the long-term consequences. These same nerves play an essential role in wound healing. We’re anxious that capsaicin could prevent wound healing, which is already a big problem for people with diabetes."
Lidocaine. Lidocaine is an anesthetic that numbs the area it has been applied to. It is available both in the form of gels and creams, both over-the-counter and by prescription. This product has several different names such as Topicaine and Xylocaine.
Other Topical Creams. Salicylate is a chemical substance that is similar to aspirin, and is found in pain-relieving creams like Aspercreme and Bengay. Cortisone creams contain corticosteroids, which are potent anti-inflammatory medications that can help alleviate pain. Each of them is available at drug stores, but there is no obvious evidence that they help ease nerve pain from peripheral neuropathy.
Prescription Medications for Nerve Pain From Peripheral Neuropathy
Many patients have to turn to prescription drug to find relief for nerve pain from peripheral neuropathy. You can choose between:
NSAIDs. Even though some nonsteroidal anti-inflammatory medications are available over the counter, your healthcare provider may recommend higher doses, or other NSAIDs, that require a prescription. There are many prescription NSAIDs to choose from such as: Celebrex, Lodine, and Relafen. People suffering from diabetes are at greater risk of kidney damage that can take place with NSAIDs. Additionally, people suffering from diabetes are more likely to develop heart disease, and prescription NSAIDs may increase the risk of heart problems.
Antidepressant drugs. Although antidepressants were created to treat depression, these medications have also become relevant in alleviating chronic pain - whether the person is depressed or not. Physicians have been prescribing antidepressant medicines for many years for pain control, claims Gibbons. Antidepressants used for the pain treatment include:
* Tricyclic antidepressants (TCAs) primarily influence the levels of the brain chemicals norepinephrine and serotonin. "These medications are the most commonly used, the best studied, and the most effective of the antidepressant medications used for pain," claims Gibbons.
Of the TCAs, Elavil has been a very good option for relieving pain, but still it has bothersome side effects. "It usually has more side effects- sleepiness, weight gain, dry mouth, dry eyes," Gibbons explains. For people suffering from peripheral neuropathy, there can be additional side effects. Gibbons claims that a lot of patients experience blood pressure and heart rate problems and get dizziness when taking Elavil.
A newer medication in this class, Pamelor, is "quite effective, with fewer side effects, so it is better tolerated," explains Gibbons. "Norpramin is also effective and has the least side effects of all."
* Selective Serotonin Reuptake Inhibitors (SSRIs) are a newer form of antidepressant medications. These medicines work by altering the amount of the brain chemical serotonin. "These are extremely effective for depression, but less effective for pain," states Gibbons. "They’ve proven their effectiveness in some research, but they’re clearly not as effective as TCAs for pain."
* Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant drugs. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.
According to Gibbons, Effexor and Cymbalta "are quite effective for pain". "They are equally effective, but lead to fewer side effects than the SSRIs or TCAs." Cymbalta is FDA-approved for painful neuropathy; Effexor is not.
Antiseizure Drugs. Medications preventing epileptic seizures can also alleviate particular pain conditions such as neuropathy for example. "The vast majority of pain patients can be treated with any of these," claims Gibbons. The medications work by controlling the unusual firing of nerve cells - in the brain and in other parts of the body, like legs and arms, he says.
* Neurontin is the antiseizure medication most commonly used for nerve pain from peripheral neuropathy. Gibbons believes that "It’s pretty effective in treatment of painful neuropathy". "It normally results in sedation or dizziness at higher doses. But if the dosage is increased steadily, it is quite well tolerated."
* Lyrica is a seizure medicine that is FDA-approved for painful neuropathy. "It is designed as the next generation of Neurontin," states Gibbons. "But if it is going to be more effective with fewer side effects- that will take time to discover."
Opioid Medicines. When pain is very severe, patients wish to feel prompt relief, claims Gibbons. That’s when they may have to see a pain specialist. Sometimes people need strong painkillers known as Ultram or Ultracet, perhaps in combination with Neurontin. "The combination gets people past that acute stage of pain while I can slowly increase the Neurontin."
Both Ultram and Ultracet are FDA-approved pain relievers containing tramadol, a weak opioid (morphine-like) substance. The medication also weakly influences the brain chemicals serotonin and norepinephrine, similar to antidepressant medications, which decreases the perception of pain.
"Frequently we use tramadol as a back-up for what is known as ‘breakthrough pain’ - pain that unexpectedly, for no apparent reason, is worse at times," claims Gibbons. Tramadol is a good replacement for over-the-counter stuff at those times."
Neuropathy experts shy away from strong narcotic opioid medicines, he underlines. Narcotics can result in severe constipation, and there is the danger of addiction. "There’s also a stigma about using a narcotic drug," he explains. ", It may appear to be a problem, depending on the type of work a person does."
More Treatment Options for Peripheral Neuropathy
For severe, intractable pain, injections of local anesthetics such as lidocaine - or patches containing lidocaine - are used to numb the painful area.
Physicians are also able to:
* Surgically destroy nerves or alleviate a nerve compression that leads to pain.
* Implant a device alleviating pain.
* Perform electrical nerve stimulation which may alleviate pain. In this treatment, small amounts of electricity are used to block pain signals as they pass through the skin. "It’s debatable is this is effective or not," claims Gibbons.
Other useful aides to improve quality of life and function include:
* Hand or foot braces can compensate for muscle weakness or help alleviate nerve compression.
* Orthopaedic shoes can improve gait (walking) problems, which will prevent injuries of feet.
