Diabetes Self-Management Articles

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Diabetic Peripheral Neuropathy

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and James Borders, MD

Treatment options
Treating diabetic neuropathy almost always involves some trial and error. Not all therapies relieve pain for everyone, so often, several therapies must be tried before one — or a combination — is found that adequately reduces pain.

Nondrug therapies. Your health-care provider may refer you to a physical therapist for treatment of diabetic neuropathy. Physical therapists have numerous tools and methods to promote ease of movement, reduce pain, restore function, and prevent disability. Treatment of neurological conditions typically includes exercises to restore motor function.

Functional electrical stimulation (FES) is a technique that uses electrical currents to activate nerves in the extremities. This can sometimes restore function in people with neurological disabilities such as diabetic peripheral neuropathy.

Monochromatic infrared energy (MIRE) therapy, most commonly known as Anodyne therapy, uses infrared energy to increase the amount of nitric oxide in the blood and in that way increase blood circulation. In some cases, MIRE has been shown to decrease numbness and pain caused by peripheral neuropathy.

Another option that may be considered to relieve physical symptoms is acupuncture, which is believed to provide pain relief by stimulating the release of natural endorphins in the brain.

Use of any of these treatments should be based on the guidance and recommendation of your health-care provider.

Topical drug therapy. Your health-care provider may recommend that you try an ointment, cream, or patch containing capsaicin to ease your pain. Capsaicin is the chemical in hot peppers that makes them hot, and it relieves the pain of peripheral neuropathy by stimulating the release of substance P, a chemical transmitter of pain, from nerve terminals. Initially, the release of substance P causes pain, but eventually the nerve terminals become depleted of substance P, leading to loss of the pain sensation. Ointments, creams, and patches containing capsaicin are sold over the counter at drugstores. It may take two to four weeks of using topical capsaicin before you feel significant pain relief.

When applying capsaicin ointment or cream, it’s a good idea to wear disposable gloves to prevent getting it on your hands, and it’s important to avoid getting it on any part of the body except the affected part. Be especially careful not to touch your eyes or mucous membranes (such as those in your nose and mouth); if you do get it on these areas, it will cause a burning sensation. When using a capsaicin patch, apply it to the skin over the affected area, but do not put it on just before you bathe or exercise.

Lidocaine patches, sold by prescription under the brand names Lidoderm and Lidopain, are another topical therapy that may be used for peripheral neuropathy. They help decrease pain and can also lower the amount of analgesics (such as aspirin or acetaminophen) a person needs to take to control pain. Up to three patches may be applied at once for 12 hours at a time in any 24-hour period.

Surgery. When nerve pain is caused by pressure on the nerve, a type of plastic surgery called nerve decompression surgery may help.

Oral drug therapy. Many people with diabetes require drug treatment to control the painful symptoms of neuropathy. Some of the drugs commonly used for this purpose are specifically approved for managing painful diabetic peripheral neuropathy, while others are not. In recent years, two drugs, duloxetine (brand name Cymbalta) and pregabalin (Lyrica) have received approval by the Food and Drug Administration (FDA) for the treatment of diabetic peripheral neuropathy. Drugs not specifically approved for relief of painful diabetic peripheral neuropathy but commonly used “off label” include some antidepressants, some anticonvulsants (seizure medicines), and certain opioids, which act as pain relievers. You and your health-care provider should discuss the pros and cons of using off-label drugs for pain relief.

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