One of the most prevalent complications of diabetes is neuropathy, or damage to the nerves. According to the National Diabetes Information Clearinghouse, up to 70% of people with diabetes develop neuropathy, particularly the longer they live with diabetes. While neuropathy can affect any nerve in the body, it very commonly affects those in the feet and legs and sometimes the hands and arms. This type of neuropathy is called peripheral neuropathy, and it can cause a range of unpleasant sensations, including tingling, burning, numbness, and pain. Treating the pain that can result from peripheral neuropathy is often difficult.
“Pain is a disease in and of itself. It tires you out. You can’t get away from it; it follows you everywhere,” says Norman Latov, MD, PhD, professor of neurology at the Weill Cornell Medical College in New York City and an expert on peripheral neuropathy.
Understanding the pain
“The pains that develop with neuropathy are what we call errant signals; they aren’t providing a realistic look at what is or isn’t disturbing us,” says Paul Arnstein, RN, PhD, clinical nurse specialist for pain relief at Massachusetts General Hospital in Boston.
Errant signals can be positive or negative. “A positive signal is when something bothers or hurts you even when there’s no tissue damage, such as a burning pain when there’s nothing hot,” says Arnstein. Another type of positive signal is when a pain is perceived as much stronger than it is. Typical examples are when even a light linen shirt hurts to wear, or the slightest touch makes someone scream.
A negative errant signal should hurt — but doesn’t. A typical example is the person who can’t tell when a pot handle is too hot and just keeps holding the pot even though it’s burning him. “Numbness is another negative pain signal,” says Arnstein, who notes that it’s one that’s known for causing problems in people with diabetes. “They can’t feel if they pick up a splinter in their foot, so one of the things we teach people with diabetic neuropathy is to carefully examine their feet every night. If they can’t do it themselves, they need to have someone help them,” he says. People with numb feet should also always wear shoes or slippers (except in bed and while bathing) to avoid injuring their feet.
Sometimes a mild neuropathy will respond to an over-the-counter drug such as a nonsteroidal anti-inflammatory drug (NSAID). Aspirin and ibuprofen are examples. However, even in prescription forms (such as Celebrex), NSAIDs “typically aren’t very helpful,” says A. Gordon Smith, MD, associate professor of neurology and pathology at the University of Utah School of Medicine in Salt Lake City.
So experts keep seeking other pain relievers. “More commonly, we use what are called neuropathic pain agents, most often antiseizure medicines like Lyrica and Neurontin. Certain antidepressants are another option,” says Smith. (Lyrica is the brand name of the drug pregabalin; Neurontin is the brand name of gabapentin. These drugs are also referred to as anticonvulsants.)
Latov offers this advice for saving money on medicines: “Ask your doctor if there’s a similar but older drug you might try. Older drugs tend to have a generic version, which is likely to cost less,” he says. As an example, Neurontin is an older drug than Lyrica and is available as a generic.
Some products for neuropathic pain relief are applied topically, or on the skin. A lidocaine patch (available by prescription) is one way to provide topical relief. Another, according to Smith, is “creams containing capsaicin, a natural substance that releases heat. It [relieves pain by damaging] the tips of the nerves that carry pain messages to the brain.” However, it also causes a burning sensation on the skin where it is applied for the first several days to weeks of application, and some people find that difficult to tolerate. (With continued use, the burning sensation should diminish.) A variety of brands and strengths of capsaicin cream are sold over the counter. “There’s a high-dose capsaicin in development,” Smith adds, “but it would be have to be applied in the doctor’s office.” The advantage of topical applications is that they don’t have systemic side effects.