Diabetic Nerve Pain And Medication

Diabetic nerve pain is also known as diabetic neuropathy.  It stems from nerve damage caused by having blood sugars that aren’t in good control in a diabetic individual. When the blood sugars are high, this causes the nerves to become damaged so that the individual experiences burning pain, numbness, and parasthesias (tingling sensations) of mostly the feet, although it can occur in the hands as well.

Diabetic Nerve Pain And Medication

Fortunately, there are medications that can be prescribed or taken over the counter that will help to control the pain of diabetic neuropathy so that the patient has some relief of their symptoms.  The approach to pain control in diabetic nerve pain involves taking medications for about 6 weeks.

If the medication does not work over that period of time, the doctor usually changes medications.  This is repeated every six weeks until the pain is resolved. After taking the medication for several months, most doctors will try to taper the dosage of medications unless the symptoms return.

The following are medications often used to treat diabetic neuropathy. Most of these medications are not true pain relievers and are not approved by the US Food and Drug Administration for the use in diabetic neuropathy but are used for other purposes:

Nonsteroidal anti-inflammatory medications (NSAIDs).

These are often used as first line treatments for diabetic neuropath. They also include Tylenol (acetaminophen), although that isn’t strictly an NSAID medication but is a straight pain reliever that acts slightly differently from true NSAID medications.  The NSAID medications generally used include ibuprofen (which is marketed as Advil and Motrin).  It decreases the pain and inflammation often associated with diabetic neuropathy.  Sometimes, the doctor will recommend naproxen sodium (which is marketed as Naprosyn or Anaprox).  This medication, too, is used for the pain and inflammation of diabetic neuropathy.  NSAIDs in general work by inhibiting inflammatory reactions in the nerves and by decreasing prostaglandin synthesis through decreasing the activity of cyclooxygenase, an enzyme often attributed to the onset of pain.

Topical analgesics

Topical medications include medications that act on substance P, which is the neurotransmitter often associated with pain. Pain relievers that are applied topically include Lidocaine gel (5 percent), lidocaine tape, and capsaicin cream (which is marketed as Dorolac, Capsin, or Zostrix). Lidocaine gel was found in a recent research study to reduce the pain of neuropathy from Herpes zoster.  The downsides of using medications like capsaicin cream include the fact that the medication takes several weeks to control the pain (by gradually reducing substance P) and the cream is messy to use when applied to the feet of diabetic patients.  Capsaicin cream is a natural chemical found in red hot chili peppers.  When applied to the affected painful areas, it prevents the reuptake of substance P in peripheral nerve cells so that eventually the nerve cells become insensitive to pain.  Substance P is a neurochemical that causes pain transmission from the peripheral nervous system to the central nervous system.

Anticonvulsant Medications.

These include medications such as Neurontin (gabapentin), Tegretol (carbamazepine), and Lyrica (pregabalin). Neurontin is one of the most commonly used medications for diabetic neuropath.  No one knows exactly how it works to decrease pain in diabetic neuropathy but it is one of the first medications used for diabetic nerve pain.  Tegretol is also used but it is considered a third line medication when all other medications fail to reduce the pain of diabetic neuropathy.  Research studies on Tegretol indicate that is does work for neuropathic pain such as is seen in diabetic neuropathy but it doesn’t seem to work as well as Neurontin (gabapentin) in controlling the pain. Lyrica (pregabalin) has been approved by the US FDA for the treatment of pain secondary to diabetic neuropathy and is generally considered to be one of the first drugs the doctor will prescribe for those patients with diabetic neuropathy.  Lamictal (lamotrigine) is another medication of this class but, according to scientific studies, it doesn’t work very well to treat diabetic nerve pain when compared to the other medications of this class.  Most of the time, Neurontin (gabapentin), Tegretol (carbamazepine), and Lyrica (pregabalin) are the anticonvulsants prescribed by doctors for treating diabetic nerve pain. Both Neurontin and Lyrica are considered first line treatments for diabetic nerve pain, while Tegretol is a third line treatment.  All are medications that have been found to treat diabetic nerve pain, even though some of them (Neurontin and Tegretol) are not specifically approved by the US FDA for the management of this type of pain. Dilantin (phenytoin) is another anticonvulsant sometimes used to treat diabetic nerve pain. It works by stabilizing the membraned of nerve cells and acts to treat neuropathic pain by increasing the flow of sodium ions across the cell membranes in nerve cells of the brain.  The downside of using Dilantin (phenytoin) for diabetic nerve pain is that it must be carefully managed, with drug levels drawn periodically while the person is taking the medication.

Tricyclic Antidepressant Medications

Tricyclic antidepressant medications are used for the pain and parasthesias associated with diabetic neuropath.  Some of these medications include Tofranil (imipramine), Pamelor (nortriptyline), and Elavil (amitriptyline).  Amitriptyline works by inhibiting serotonin reuptake and possibly norepinephrine reuptake between the nerve cells, which makes it a good medication for the treatment of nerve-related pain.  Tofranil is typically used as an antidepressant that works by increasing norepinephrine in the spaces between nerve cells, thus reducing nerve pain.  Pamelor (nortriptyline) has been shown in research studies to be effective in treating all kinds of chronic pain, including diabetic nerve pain.  It works by blocking the reuptake of both serotonin and norepinephrine by presynaptic nerve cells, decreasing the transmission of pain signals between nerve cells.

Selective Serotonin/Norepinephrine Reuptake Inhibitors (SSNRIs)

These types of medications have been shown to reduce the pain caused by diabetic neuropathy.  Two commonly used medications of this class include Effexor (venlafaxine) and Cymbalta (duloxetine).  Cymbalta was the first medication of this class to be approved by the US FDA specifically in the management of diabetic nerve pain.  It inhibits the reuptake of both serotonin and norepinephrine by presynaptic nerve cells in both the brain and in peripheral nerves.  Effexor has not been approved for the treatment of diabetic nerve pain, although many doctors prescribe the drug for this use.

Selective Serotonin Reuptake Inhibitors (SSRIs)

These are medications normally used for the treatment of depression but are often used as second or third line medications in the treatment of diabetic nerve pain.  Medications of this class include Paxil (paroxetine) and Celexa (citalopram).  Both are generally used to treat depressive symptoms but seem also to be effective in the management of pain secondary to diabetic neuropathy.

Antiarrhythmic Medications of Class Ib

This includes lidocaine, which is marketed as Dermaflex gel, Anestacon, and Lidoderm (dilocaine).  It is applied topically as a 5 percent gel to the affected painful areas and has been found in a placebo controlled research study to decrease the pain of diabetic neuropathy.   Lidocaine tape is another form of lidocaine effectively used to treat diabetic nerve pain.


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