Diabetic Nerve Pain

Medications to Treat Diabetic Nerve Pain

You can soothe the pain of diabetic neuropathy when controlling blood sugar isn't enough.

By Rebecca Buffum Taylor

Reviewed By Brunilda Nazario, MD

Diabetes is a lifelong companion. Sometimes a complication like diabetic nerve pain takes time to resolve, and you may want to try different treatments and medications before finding one that works for you.

First, make sure you're doing the best job you can of controlling your blood sugar, exercising regularly, and keeping your weight normal. If you still have pain, numbness, or discomfort in your feet or hands (called peripheral neuropathy), you may need to turn to medications to soothe your nerve pain and help you sleep. These days, you have a wealth of options to try.

"We try to find what works for each individual, because there isn't really anything that works for everybody," says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle.

As with any medication, it's up to you to weigh the risks and benefits of a drug, given your own medical condition. Talk with your doctor about whether the expected benefits of symptom relief outweigh any potential risks of the drug.

A Nerve Pain Primer

When you're reading labels in a drugstore or talking with your doctor, it helps to know the lay of the land. Here are some common terms:

 Analgesic: a pain reliever.

 Anti-inflammatory: reduces inflammation, the body's natural response to injury,  from sunburn to the nerve damage of diabetes.

 Nonsteroidal anti-inflammatory drug (NSAID): reduces both pain and  inflammation, since inflammation can increase pain, and a drug that soothes  inflammation can also help relieve pain.

Diabetes Nerve Pain: Over-the-Counter Pain Relievers

For mild pain, you may find relief with medications you can buy in a drugstore without a prescription, often called "over-the-counter" drugs.

 NSAIDs. Aspirin, Advil, or Motrin (ibuprofen), as well as Aleve (naproxen), are  all common, over-the-counter NSAIDs that relieve pain and inflammation from  diabetic nerve damage. But because people with diabetes already have a higher risk  of kidney damage, the increased risk of kidney and liver damage from long-term use  of NSAIDs is a critical concern. NSAIDs can also cause stomach irritation and  bleeding, high blood pressure, and fluid retention if you take them regularly for  weeks or months.

 Tylenol (acetaminophen) aims to soothe pain but doesn't address inflammation.  The plus? It doesn't cause the same stomach irritation that NSAIDs do. The minus? It may  not be as effective in treating nerve pain. "We still recommend it," says Trence, "but most  people find that Tylenol is probably not very helpful for people with painful neuropathy."  One risk to consider is liver damage from long-term use.

Creams, Gels, and Oils

For mild symptoms of diabetic nerve pain, topical creams and gels -- meaning you apply them directly to your skin where it hurts -- may bring you relief.

 Capsaicin. Capzasin-P and Zostrix (capsaicin), made from crushed chili peppers,  comes in a cream or roll-on form. It works by depleting nerve endings that pass  chemicals from one nerve to another to transmit pain signals, Trence says. "You  have to apply it four to five times a day," she says, "and it takes a couple of weeks to  be effective." One risk: it may interfere with wound healing, which is often a  problem for people with diabetes.

 Lidocaine. This topical anesthetic numbs the area where it's applied. You can  find lidocaine in nonprescription cream or gel form, or in a prescription-strength  patch or injection to relieve pain.

 Other creams. Save your money and don't bother with drugstore creams like  Bengay or Aspercreme, which haven't been proven to relieve diabetic neuropathy.  The same goes for creams containing cortisone; while it may work for other kinds of  pain, cortisone hasn't been proven effective for diabetic nerve pain. Remember to  take these drugs as directed.

 For chronic disabling pain, botanical oil blends may provide rapid yet temporary relief.

 Botanical extracts. A blend of botanical extracts, such as Neuragen, may  provide rapid relief of neuropathic pain.

Diabetic Nerve Pain: Prescription Relief

  NSAIDs (nonsteroidal anti-inflammatory drugs). Common brands of  prescription-strength NSAIDs include Celebrex, Lodine, and Relafen. The risks with  taking these drugs are similar to taking over-the-counter NSAIDs, although there's an  added risk of heart problems.

 Antiseizure drugs. First created to prevent the chaotic firing of nerves in  seizures, drugs such as Neurontin and Lyrica are now known to have anesthetic  qualities. "They help people deal with pain," says Trence, and may also help people  deal with depression that can accompany the disability associated with painful  neuropathy." A similar drug, Cymbalta, used for depression and approved for use in  neuropathy, may help with the pain threshold issue, says Trence.

 Antidepressants. It may sound curious, but antidepressants can help relieve  diabetic nerve pain -- whether you're clinically depressed or not. And since  depression is a common reaction to chronic nerve pain, an antidepressant can bring a  double benefit by relieving both depression and pain.

 SSRIs (selective serotonin reuptate inhibitors), such as Paxil or Prozac, may  work by increasing the level of a "feel-good" neurotransmitter called serotonin.  SSRIs are more effective for depression than for pain, thus may be a good choice to  treat both depression and nerve pain.

 SNRIs (serotonin and norepinephrine reuptate inhibitors), such as Cymbalta or  Effexor, work by changing the levels of two neurotransmitters: serotonin and  norepinephrine, involved in the stress response and release of glucose from energy  stores in the body. These drugs are generally more effective than SSRIs for  peripheral neuropathy.

 Tricyclic antidepressants, such as Elavil or Imipramine,don't deal with nerve  pain directly, says Trence, but they make people drowsy, so they sleep better and  their pain threshold is lower. "Most people have moved away from the tricyclics  because of the potential side effects of dry mouth, constipation, fast heart rate," says  Trence.

 Opioids such as morphine. The painkiller Ultram is often used for moderate to  severe pain, while Ultracet is used for short-term relief of severe pain (up to five days). The  drugs can cause dependency if used long-term. "People using these drugs unfortunately  tend to get habituated," says Trence, "but occasionally a low dose, or maintenance dose,  can be very helpful. It may be the only relief they get."

Medications to Treat Diabetic Nerve Pain

You can soothe the pain of diabetic neuropathy when controlling blood sugar isn't enough.

6 Medication Safety Tips

1. Always talk with your doctor before starting a new medication -- even nonprescription drugs or herbal remedies. Any new, active ingredients you're adding to your body can interfere with how your diabetes medication works or cause side effects.

2. Keep a current list of all medications -- and the doses and time you take them. Bring your list to each doctor's visit, including any specialists you may see for diabetes or nerve pain.

3. Make a note of any strange reactions or side effects you experience from medications you're taking. Some side effects just have to be lived with; other times, your doctor may be able to suggest a different brand, dosing, or timing of a medication, to reduce side effects.

4. Be prepared to try different medications or doses until you find the right one for you. You may be on several types of drugs -- for diabetes, blood pressure, cholesterol, or nerve pain -- so it can take time to find the right combination that's effective with the fewest side effects.

5. Throw away any expired medications. Drugs past their expiration date are never safe to take, so check the label for the expiration date if you're not sure.

6. Talk with your doctor or pharmacist if you have any questions on how to take your medications, your dose, or the timing of each dose.

For Severe, Chronic Pain

Consider seeing a pain specialist to ask about options beyond medications. If pain has changed the way you walk, a foot brace or orthotics can help you return to normal activities. In some cases, electrical nerve stimulation or surgery to destroy the affected nerves may be advised to help block pain and relieve the worst of your symptoms.

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Reviewed by Brunilda Nazario, MD on June 02, 2009