How to Treat Pain from Diabetic Neuropathy

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Are you suffering from pain in your feet, feet or hands with diabetic neuropathy? This is a particularly frustrating and not underestimated state. And for those seeking relief, it is typical to have to try many different treatments before hitting a functioning combination.

The pain of diabetic neuropathy is exactly the kind of condition you may need the wisdom of those who were there before. We reviewed over 100 comments on Facebook groups and forums to get ideas on how a community of ordinary people with diabetes can address this issue.

This article explores both the mainstream science of neuropathy pain relief and the daily advice of everyday community members of diabetes.

What is diabetic neuropathy?

Diabetic neuropathy is a type of nerve damage that is common in diabetic patients. Neurological disorders can affect many parts of the body, including the digestive system, heart, eyes, bladder, sweat glands, and genitals.

Nerve damage that affects most of the feet, hands, feet and arms is called peripheral neuropathy. This condition is often very uncomfortable, with patients feeling pain, tingling, burning, stinging, numbness and a complete loss of emotion in the limbs. The pain may worsen at night. These symptoms are generally first noticed in the feet.

Diabetic neuropathy, like other diabetic complications, is ultimately caused by chronic hyperglycemia. If you begin to notice any pain associated with this condition, you should immediately visit a doctor or endocrinologist. Diabetic neuropathy may indicate that you are also at risk for other serious complications.

Blood sugar control

If there is one treatment for neuropathic pain that the daily diabetic community can truly support, it is optimal blood glucose control.

Diabetic neuropathy is caused primarily by hyperglycemia. Achieving lower, healthier blood glucose is the best way to address the underlying causes of neuropathy and may provide both short-term and long-term relief. It is unclear whether nerve damage can be reversed, but excellent glycemic control can prevent further damage.

If there is another good reason to prioritize glycemic control, it is the fact that diabetic neuropathy is an early warning sign of highly dangerous diabetic complications. The feet of neuropathic patients may ultimately be unable to heal the healing wounds, with “compensation of the limbs, systemic infection, sepsis, and even death.” Some of our community members are in a frightening battle with sepsis.

Prescription drugs

Do not hesitate to talk to your doctor about prescription medications in this condition. Medicines don’t work for everyone, but they may work for you.

In our community, the most popular medicine treatments are Gabapentin (neurontin). Gabapentin is an oral prescription drug that acts on the brain and changes the way you perceive pain. It is also used as an anticonvulsant to prevent seizures in patients with epilepsy or related conditions.

Your doctor may start you with a low dose and you may need to increase the dose to feel the effect or if the condition worsens.

Gabapentin doesn’t work for anyone. A rigorous study found that only 35% of study participants enjoyed significant pain relief compared to 21% who received the placebo, and that “more than half of those treated with gabapentin are not worthy of pain relief.”

Gabapentin can have side effects such as skin problems, dizziness, and drowsiness. A small number of users experience intense mood changes, including suicidal ideation.

Lyrica (pregabalin) It may be the second most popular drug neuropathic pain in our community. Lyrica is associated with gabapentin, which belongs to the same class of anticonvulsions.

Evidence suggests that Lyrica and other pregabalins have similar effects as gabapentin. A large review concluded, “Some people will benefit substantially from pregabalin. There will be more benefits, but many will either not benefit or will stop treatment.”

The American Society of Neurology (AAN) officially recommends three other drugs to treat diabetic neuropathy. These three are less defined and as a result, they are less commonly discussed in our community.

• Serotonin – Norepinephrine Reuptake Inhibitor (SNRIS)including duloxetine, venlafaxine, and desalted lafaxine. SNRIs are antidepressants prescribed for a variety of mental health issues, including anxiety and obsessive-compulsive disorder. They are effective in reducing neuropathic pain and, as a bonus, can improve mood and other quality of life factors.
• Tricyclic antidepressants (TCA)amitriptyline, nortriptyline, imipramine, etc. TCA is also an antidepressant drug and has been used for decades. TCA is considered “effective” in the treatment of neuropathic pain, but is associated with side effects, including weight gain.
• Sodium Channel Blocker (carbamazepine, oxcarbazepine, lamotrigine, valproic acid, lacosamide, etc.). These drugs are used to prevent seizures, such as gabapentinoids (including gabapentin and pregabalin). Sodium channel blockers are often not prescribed because of possible side effects, but AANs conclude that they have similar ability to relieve pain as a previous drug.

AAN believes that the above drugs are roughly similarly effective and therefore should make recommendations based on “potential adverse effects, patient comorbidities, cost, and patient preferences.”

Another important thing to note here is that none of these drugs are completely effective and doctors cannot fully predict which drugs will function in which patients. Diabetic neuropathy is a mysterious condition, and experts don’t fully understand why drugs occur and do not work to reduce pain. It may take months of experimentation using a series of medications.

Finally, words Opioids. These powerful painkillers are, in fact, the most commonly prescribed treatments in the United States for diabetic neuropathy. However, they are not popular in the daily diabetic community. That might be the best. AAN experts believe that drugs should not be prescribed for this type of chronic pain. Most doctors don’t seem to know the recommendation. A tragic 2020 study in the journal pain Most patients were prescribed opioids “before trying one of the guidelines’ recommended medications for peripheral neuropathy,” and found that too many patients were receiving chronic opioid therapy. The horrific effects of opioid addiction are now very well known.

Mental health and sleep

That may sound surprising, but the American Neurological Association recommends that people with pain caused by diabetic neuropathy should seek treatment Sleep disorders and mood disorders First, before exploring pain relief medication.

Mood and sleep improvements don’t actually address the underlying causes of painful diabetic neuropathy, but they change us significantly Sensation Of pain.

It makes sense that it is suitable for dealing with chronic pain and is better equipped with happy and happy people. If that sounds too obvious, consider that diabetic people suffer from both depression (and related mental health issues) and sleep disorders much more frequently than average, and these conditions are too commonly recognized and untreated.

The next time you meet your healthcare provider, consider whether you should discuss sleep and mental health, along with the pain and discomfort of neuropathy.

Local treatment

There are a variety of over-the-counter creams and sprays available for neuropathic pain. Experts are optimistic about the use of topical treatments, but scientific evidence of its effectiveness is a bit vague.

The AAN Guidance rated four topical treatments as “probably more likely to improve pain than placebo.” These treatments include:

• Capsaicin
• Nitrosense patch
• Citrullus colocynthis
• Glyceryl Sanyo Itrate Spray

Another recent review identified many chemicals that could be useful, including Botox injections. This second review highlighted the lidocaine and capsaicin patch as two treatments with particularly excellent data supporting its effectiveness.

One of our community’s favorite brands is Biofreeze, which uses menthol as an active ingredient. BioFreeze is available in a variety of application forms, including sprays, gels, patches, wipes and more.

But simply put, no one really knows which topical treatment is most effective and what works for you may not work for someone else. It probably takes trial and error to find the product you like. It is best to work with your doctor to find a good option.

exercise

Exercise is a difficult subject for people with neuropathic pain, as the training itself can cause that pain. There is also the fear that exercise is likely to cause problems for people with sensitive feet.

However, there is evidence that exercise is healthy for these damaged nerves. A 2014 review concluded that “it is important to understand that routine exercise can help prevent some of those causes (of neuropathic pain), but it has also proven to be an effective tool to alleviate some of the most disastrous symptoms of the condition.” And experts argue that the benefits of exercise outweigh the risk of foot injuries.

Exercise is also an important part of the overall treatment plan for diabetic neuropathy. Even low-intensity exercise is known to lower both blood sugar and cholesterol, prevent weight gain, and improve both mood and sleep. All of these help combat both the root cause of neuropathic pain and the ability to withstand pain.

Cannabis and CBD

When voting for the Daily Diabetes community, perhaps the biggest surprise was how enthusiastically our readers supported cannabis for relief from neuropathic pain. Many people rank it as their favorite way to reduce or deal with pain and discomfort.

In fact, there is some evidence that cannabis may be effective. A small number of 2015 studies found that “inhaled cannabis showed a dose-dependent reduction in diabetic peripheral neuropathy pain.” Similar results were found in follow-ups from the same team.

Generally speaking, experts are a bit hesitant. In 2021, the International Association for Pain Research announced that it cannot support the use of cannabis for pain relief due to the lack of good scientific evidence. The organization also noted that there is a significant research gap and many work to do.

If your area allows medicinal cannabinoid products, your doctor may be happy to write a prescription for you. If adult cannabis is permitted, no prescription is required. Nevertheless, it should be noted that the legal situation of cannabis use is confusing in the US. Although illegal at the federal level, more and more states are passing through new legislative legislation, increasingly grey areas are emerging, both medicinal and recreational.

For more information on cannabis and diabetes (including blood glucose effects and special warnings for patients with type 1 diabetes), read articles, marijuana and diabetes, and more.

Also, some community members recommend CBD oil. This applies directly to consumption or skin. Most health authorities believe that evidence in favour of CBD oil is very thin, and patients are careful to be vigilant about anecdotes and marketing claims. Is CBD oil just snake oil? It’s impossible to say. Some members of our community believe it works. There is some evidence that CBD oil can reduce neuropathic pain.

Height feet

Peripheral neuropathy suffers most from the feet than any other body part. Diabetes can lower blood flow to the legs, which leads to all kinds of problems, such as slow wound healing and increased risk of infection.

Insufficient blood flow can contribute to nerve damage and pain in the foot. Raising your legs can help relieve the pain.

When practical, raise your legs while sitting. Stand up, stretch your legs, and occasionally take your feet and toes. If you’re in bed, tingling, burning and pain is the worst, even while you’re sleeping, try experimenting by placing it on a pillow and raising your legs.

Soak your feet

Many people with diabetic neuropathy are relieved quickly from a good bath. Go a step further and include Epsom salt in the soaking ritual.

A 2020 survey found that electric foot baths filled with salt water provided significant pain relief. (It didn’t work for a salt-free hot bath).

However, it is important to know that major diabetes authorities do not agree to this advice. This is because long soaking may not be good for vulnerable feet patients. The American Diabetes Association states very clearly: “Don’t soak your feet.” If your feet are prone to slow, healing wounds, it may be wise to pay attention to this treatment.

Compression socks

Opinions differ on the wisdom of wearing compressed socks. Several sources argue that gently squeezing the lower extremities promotes healthy blood flow. Others claim the exact opposite, saying compression socks limit blood flow.

Compressed socks are the most popular among people with diabetes who have swelling problems in the legs and legs. Studies have shown that compression socks are effective in treating lower leg edema without compromising circulation. However, we were unable to find published studies assessing compression socks and pain due to diabetic neuropathy.

While some members of our community find it useful in treating neuropathic pain, many experts consider it a bad idea for people with diabetes. The National Institutes of Health tell people with diabetic foot problems to “don’t wear tight socks.”

Alpha Lipoic Acid

Alpha-lipoic acid (ALA) is a fatty acid and antioxidant that can be found in both the human body and in many foods. It has been proposed as an alternative treatment for many conditions, including neuropathic pain.

Several members of our community take a picture of ALA supplements (which can be easily found at most pharmacies). The ALA is theorized to improve “neurological blood flow, nerve conduction velocity, and several other measures of nerve function.” And there is some scientific evidence that ALA can really help relieve neuropathic pain.

Vitamin b

Vitamin B has a complex relationship with the human nervous system. Too little or too much certain B vitamins can directly cause nerve damage.

Some daily diabetes readers take vitamin supplements, which they believe are useful for neuropathic pain. However, science is unknown. A review of 13 studies concluded that “there is insufficient evidence to determine whether vitamin B is beneficial or harmful,” but that supplements are “generally well tolerated.” There is some weak evidence that vitamin B12 may be useful.

massage

Whether they do it themselves, persuade a loved one or hire a professional, some of our community members find relief from massage. The science on this has not been resolved accurately, but Google’s quick search shows that there are many protocols for massage to relieve pain from neuropathy.

We have identified two studies that have found significant pain relief from aromatherapy massage, but it is unclear whether aroma oils or massages are a key component or necessary for remedies. A 2016 survey found that “tie foot massage” achieved important results, and a large-scale meta-analysis in 2019 found that Chinese shiatsu massage combined with Chinese medicinal foot baths brings improvements.

Of course, there is no need for randomized controlled trials to find out if a bit of rubbing your feet feels good. This can be considered a non-drug therapy with few drawbacks. It’s worth trying.

Spinal cord stimulation

Spinal cord stimulation requires implantation of a small device on the back. The device provides gentle electrical pulses to the spinal cord along the thin wire. These pulses essentially block pain signals from reaching the brain. Spinal cord stimulation has been used for many types of chronic pain for years (the most commonly used in the US for the failure of reverse surgical syndrome).

Scientific evidence in fascinating the spinal cord stimulation of diabetic patients is encouraging, but it still emerges. A 2021 review noted that there are no long-term trials of blinded, randomized technology yet, but observational trials suggest that many patients enjoy long-term pain relief. The American Clinical Endocrine Association has recently supported high-frequency spinal stimulation as an option for people with “painful diabetic peripheral neuropathy that has failed at least one drug therapy.”

Diabetes suffered from truly debilitating pain every day, and I spoke to a man with type 2 diabetes who had no luck with many other treatments and many other treatments discussed in this article, but spinal stimulation has greatly improved his symptoms.

When nothing works

Unfortunately, some of our community members have never found anything that can help relieve the pain. If that is the case, we recommend that you readjust your glycemic control and consider lifestyle changes that can help reduce stress and promote superior mental health.

There are also many resources for people dealing with chronic pain, such as the American Pain Foundation, which has extensive information on coping mechanisms and self-management techniques. As the American Psychological Association states, “Mental and emotional health is equally important. Psychological techniques and treatments help build resilience and teach the skills needed to manage chronic pain.”

Take home

There is no simple answer to pain caused by diabetic neuropathy. Patients who find relief often use a combination of prescription medications, over-the-counter treatments, and non-medical techniques such as massage and foot lifting. Excellent blood glucose control is the only treatment that addresses the underlying cause.

If you have neuropathic pain, seek treatment from a medical professional immediately. The problem will be dealt with earlier and later, and you may need to do some experiments to find the one that suits you.