Neuropathy

Treating Painful Diabetic Peripheral Neuropathy

The toes burn and tingle and sharp pains shoot into your legs. The bed sheets feel uncomfortable on the feet as you toss and turn, trying to get some rest. Your feet felt numb throughout the day, but now feel like they are on fire. Nothing seems to help as you watch the hours on the clock pass by, hoping to fall asleep.

Burning, numbness, tingling, hot and cold sensations, shooting and electrical pain are common sensations felt at rest in painful peripheral neuropathy. Neuropathy is an abnormality of the nervous system. There are many different types of neuropathy, but the most common neuropathy effecting diabetics is peripheral neuropathy.

Diabetic neuropathy is described as a loss of sensation that starts in the tips of the toes and gradually works its way up the legs, and in severe case into the hands. It is sometimes referred to as a stocking glove neuropathy because it progresses as if one was pulling on a stocking.

Sixty percent of diabetics have some type of neuropathy in their feet. Five percent of diabetics will experience painful diabetic neuropathy and the incidence increases with age. Over 45% of individuals who have had diabetes for over 25 years will experience some symptoms of painful diabetic neuropathy.

The cause of diabetic neuropathy is not clearly understood. Many believe that the damage to the small vessels surrounding the nerves, from the diabetes, causes damage to the nerves. Others believe the increase in blood sugar causes damage to the nerves. Despite the different theories, studies have shown better blood sugar control helps prevent progression of the neuropathy.

There are currently no treatments to help reverse diabetic neuropathy. There are no treatments which help reduce the numbness. But, there are many treatments to help decrease the pain associated with the neuropathy.

Your doctor may prescribe medications to help with the pain. There are many options, but until recently none were FDA approved for the treatment of painful neuropathy. Cymbalta®, duloxetine HCl, was recently approved by the FDA in September of 2004 for use in diabetic peripheral neuropathy at doses of 60 and 120 mg per day. This is the first drug approved for this use. Similar medications, like amitriptyline, desipramine and nortriptyline, have been used to help decrease pain and help with sleep.

Gabapentin, also known as Neurontin®, has been a successful treatment for painful diabetic neuropathy. Neurontin® was originally approved by the FDA for adjunctive use in seizures, but the benefits of this drug for other conditions, like neuropathy, soon became known. The manufacturers of Neurontin® were caught up in a controversy regarding their marketing tactics for this off label use. Many physicians still use this drug despite the controversy. Tegretol and Dilantin, common seizure medications, can be used in more severe cases. New treatments include lidocaine 5% cream, acetyl-L-canitine, nerve growth factor and Annodyne ®, infrared therapy.

To help treat painful peripheral neuropathy without prescription medications, consider the following tips:

1. Keep your blood sugar in control: Studies have shown that when blood sugars remain high, or roller coaster from high to low, peripheral neuropathy will worsen.

2. Exercise. This is probably the last thing you wanted to hear. Exercise helps increase circulation and stimulates the growth of new vessels which help slow the progression of the neuropathy. Exercising also helps to increase your pain threshold and to provide a distraction from the nerve pain in your feet.

3. Eat healthy. Besides helping to control your blood sugar, eating a wide variety of fruits and vegetables will add anti-oxidants to your diet. Anti-oxidants will combat the damaging oxidative effects glucose has on your nerves. In particular, try dark-green, leafy vegetables, yellow, orange, and red fruits and vegetables, citrus fruits and tomatoes.

4. Try red pepper powder. Capsaicin is the active ingredient in chile peppers. When applied to the feet it acts as a counter-irritant and can help decrease neuropathic pain. Capsaicin can be purchased at your local drug store. If you cannot afford capsaicin, try mixing 1 tablespoon of dry chile powder with 2 tablespoons of baby powder. Place the mixture in a sock and use the socks at night.

5. Try alpha lipoic acid. ALA is an effective anti-oxidant that has been shown to relieve pain associated with neuropathy in multiple studies. To help relieve pain, the dose must be at least 600mg a day. It is advisable to start with a lower dose, as higher doses can cause nausea, stomach upset, fatigue, insomnia and can lower blood sugar. In general, ALA is a safe supplement.

6. Try gamma linolenic acid. GLA is an essential fatty acid found in evening primrose oil. Most of the studies have shown modest results, but the possibilities are still encouraging. Take 360mg/day. Many indications require higher dosages, but side effects with long term use at higher doses may include inflammation, thrombosis (blood clots), or decreased immune system functioning.

Treating painful diabetic peripheral neuropathy is very difficult and many of the above mentioned therapies should be tried and combined. Don't expect any "cures" and make sure you give each therapy a chance to work.

Christine Dobrowolski is a podiatrist and the author of Those Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot Problems. To learn more about Dr. Dobrowolski and her book visit SkiPublishing. To learn more about diabetic foot care visit NorthcoastFootcare/diabetes

Comments

cross-reference

james reynolds wrote on 2009-11-25    


pain relief-neuropathy-also see Gullain-Barre syndrome, esp. AMAN type. Not only may there occur varying degrees of motor nerve loss, but after also may have significant sensory symptomatlogy.

please help...

danielle wrote on 2009-11-25    


my mom is a 49 year old woman that was diagnosed with neuropathy.along with a 10 year vomitting issue that has never been solved...although her legs and feet hurt her tremendously she could still function and walk.she got one of her stomach attacks as she called them ang laid in bed for weeks hoping it would go away...she also before this was getting iv-ig treatments eight months prior..only every two weeks for two hours.finally we go to her house to make her go to the hospital and she falls to the ground...we thought it was due to dehydration....but no we still dont know what happened...mri,eeg,and ct scan showed nothung.then she started talking like she had mental problems..believing people were in the room that was not..and not even knowing she was in the hospital...her doctor sent her home..thinking she is making this all up fpr attention....my mom is not crazy nor needs attention... yet she is crippled and cannot walk or get off the couch or use her hands..we have to take turns taking her to the bedside pot...her second doc.ordered her iv treatments again cuz for awhilr he was mia cuz he moved away to practice elsewhere...we really dont know the cause pf this abrupt crippledness that took over her..she feels like there is glass in her hands and feet and cannot use either of them because they are completley numb...anyone have any info about the iv therapy???we are hoping that after some treatments she can possibly walk again

What is Anodyne Therapy?

Goldie wrote on 2009-11-24    


I'm 55 y/o and the pain is getting so bad .I hurt almost all the time.My health care provider has me on Cymbalta and Neurontin and it did work for a while.Please give me some info. on what that therapy can do and how it works. Thanks so very much

Katherine Williams wrote on 2009-11-21    


What is Anodyne

Stroke Neuropathy

MichaelP wrote on 2009-11-20    


Five years ago(2004) I suffered a massive strokeon the right side,frontal lobe. My left arm and hand are paralyzed. My left leg craps at night and makes sleep difficult. I was given Gabapentin by my Dr for the pain of my neuropathy.I am i8nvolved in an intensive exercise program with a goal of being able to walk unassisted before next year. The exercise seems to help,reduce the neuropathy pain.

pain relief

altamease cole wrote on 2009-11-20    


I was on 1000mg of lyrica a day and the only thing that i have found to work so far was dropping my dose down and taking epson salt baths every night... so try that and see if it helps i have tired numerous things anywhere from even having to go to pain management and have electric shock threapy nothing else has really worked since

Pain, bladder nerve loss, colon non stop pain legs arms hands you name it

Abegail Satiago wrote on 2009-11-17    


I have been fighting this disorder and was just finally diagnosed, and have been told, this is fibro, though I have severe pain, on 100 mcg/hr of fentenyl, and a host of other stuff. I can not take the neurontins or the anti depressants, its as though I turn into a drooling stiff frankinstein. I am enduring the word drug addict and hate it, it hurts and thus, I have not asked for an uptake at all, after all, this was only severe fibro, sever degenerative disease, talking head to pelvis, likely down to feet, but mri showed several brain lesions, 8 at least, and though I can not pee, and my bowels do not stop and I do not leave the house, and when my feet and hands became numb to the point of not being able to use them I was sent to the er, scamed at that to attempt to have me admitted to the in patient nut house. devasted, as I was, I continue on, and finally I went to a doc who had done one spine injection which helped enough to get my pain in legs down, but he asked me to do an emg, and that doc my word said girl, you have some shit going on, why are you not on oxy or something more powerful, and he tested me for four hours, my colon is diagnosed, as colitis, my bladder was tested with uro dynamic tests and I had all the tests to show, and I hurt so bad, that despite no contrived evidence I was called luny, but I go I get migraine shots and he helps me a lot, and bi weekly shots in neck arms legs, and I happen to love the man, he was been very careful, and did not want to hurt me. when oxy came up, the word drug addict came out, by a staff member, and yet I will continue but when the other guy said this is per neuro I started to cry and given he could see the pain on the machine and noted my 30 pound weight loss, and the fact I was in so much pain, he had a hard time doing portions of the test. Crying because it was real, and scared as I did not know what to do. I need at least 2 or 3 surgery's both hands are shot, the elbow is too, and why this name called occured I do not know, and further on the other remedies known, I almost got fired, as neurontin made me appear and talk like frankenstien or herman munster and those freaking ssri's or shut up go away happy pills my 3 kids said they lost their mom, I tried them all, at times I could not talk, and if I had lost my job, it was saved due to a lawyer and doc getting involved as the people I worked for, my friends, ?? for 25 years were spying on me and they knew I had sickness and was on meds, but it took a few bad woman and a couple of bad men I was told cared about me, to just about kill me, and to this date, 4 years now, I still cry that I walked out with all at my work thought I was insane, simply put, those who can not take the first choice are not nuts, but can go nuts and by no means am I bi polar, I am still suffering from what would be post trauma, as I worked 7 days a week as I could not keep up, the last few years I worked, and to have this happen, was the worst thing ever. the diagnosis saved me, my mind, and I cried with the vindication, but fear the next step. The wonderful man said I need much more pain relief and though on fentenyl I wake daily screaming and I know this last month with my hands have been utter hell, to wit, I now know, its a problem, and why no tests dispite begging for them came _ I finally got the tests and I do not suffer from the no name fibro. I was told by a doc, docs laugh at this, like anyone with it is nuts, and its the last thing a person with this could endure, but I knew I had no fibro, I knew I had MS or nuerathapy, and thank this fine man who just tested me. I am so grateful to another doc, who though all of this, and I list no names, as we are all human, and though all of this, I love all 5 docs I see, knowing everyone is simply human. I know now, the next years may be better, I may even be able to go to dinner, a fact I can not do, as I have this bowel that does not wait, keeping me far too thin, (I am guessing as tests showed I do actually absorb) this remains a mystery. my reply is just empathy for any person in this maze, as it is scary and so complex and I have found it to be the worst ever as it rather takes your life and leaves you or for me, has kept me at home in bound most days with trips only to the docs, and no friends, as I can not call my pals at my former job. They will fire me if I do, and if I reveal who they are or what the award is, hence its company a, and I have to leave a fake name, and all,so I can read and think and share the hells I have had. I pity any person stuck in an HMO, I got out, as I was brandd there, as nothing wrong with her but colitis, and she should take out her colon was what the neuro said there. what have I learned, keep asking, be nice never put a human down, errors happen, and for me, I finally got info I need, and to wit, and sipite all the evidence I had to do this in a war zone. my freinds are with me in spirit and I found I had a mere few - this disorder is terrible, but I have learned to fight and to love out of all the errors that is a good thing. not really much help but I do hope someone fighting for tests, mri, and emg, keep fighting the good war and never blame the docs that don't work with you, move on, and find one that will, and know it may take years, I amnot familiar with Anodyne therapy and I do not have diabetis. best to any oen out there fighting the big human war of getting your life on board. The time will come if you do, and each time I realize this, I amost beg or go to another for an opinion, no more waiting, I know I am not nuts. long but I do hope I help someone who is sick and is not getting tthe tests they need. Get them before your insurance says pre -existing if you are in a position of losing a job, as its a tight mean worldout there in insurance land, my husband is a broker and he knows that war and has not focused on group or individual coverage for the last few years, as its not something in his control, only we as consumers when well are able to buy or if we left the company on a Long Term disabily, and had insurance when we left will have the luck of the draw dispite the horrid end. please no emails, my name is revealed and I can not have that as I will lose it all, its part of the deal, and that is insurance as we all know this is an expensive disorder, my costs out of pocket with the best coverage went to 23,ooo for a family all under me of four people - for just about free. At my age, 56 that is a huge deal. I do wish the other meds worked on me, but if its not bad to say, having sex is the one pain reliever that is normal and natural, and at that for me, its difficult as my gut is bad, but and so, I have to find a way to do such things as that, so a natural pain reliever is released.

treatment for neropathy

altamease cole wrote on 2009-11-15    


I am presently taking lyrica 75mg twice a day. side affect from chemo.Is there something else out there that will help me?

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