Managing nerve pain in diabetes

By Susan Lutz, PharmD Mar 11, 2022 • 7 min


What is diabetic nerve pain?

Diabetic nerve pain is pain that is caused by nerve damage resulting from high blood sugar levels that are not under control. This is also known as diabetic or peripheral neuropathy, and it typically affects the lower extremities. There are a number of options for managing diabetic nerve pain.

Peripheral neuropathy is the most common type of nerve pain found in people with diabetes, affecting 30% to 60% of the diabetic population. Pain occurs first in the feet and legs and can be followed by the arms and hands if blood sugar levels are not kept under control. Symptoms of peripheral neuropathy usually get worse at nighttime.

Peripheral neuropathy symptoms might include:

  • Numbness or decreased ability to feel pain or temperature changes
  • Tingling or burning
  • Sharp pain or cramps
  • Serious foot problems (including ulcers, infections, bone pain or joint pain)

Risk factors for developing diabetic nerve pain are out of control blood sugars, being overweight or obese, and having a large waist circumference. In addition to worsening diabetic nerve pain, having decreased feeling in your feet can lead to foot cuts or sores that do not heal — possibly resulting in amputation.

Can nerve pain be reversed in diabetes?

Prevention and slowing progression of nerve damage.

By being aware of blood sugar levels and keeping them under control, people living with diabetes can help themselves have a lower risk for complications like diabetic nerve pain. There are two ways for people to keep track of their blood sugar:

  • Use a blood glucose meter and test strips to test sugar levels one or more times a day. Keeping a written record of this to show the provider is helpful; this would help a provider easily change medication if sugar levels are not being controlled.
  • Get an A1c test done at the provider's office or lab every 3–6 months. This test provides the average blood sugar level over the last three months.

Exercise and weight loss are other ways people living with diabetes can help lower their risk of getting diabetic nerve pain or help decrease the pain if they already have it. It's important to remember that while these activities help decrease nerve damage and pain, they may not completely take away all the pain.

Treatment

Finding the right medication or treatment for someone with nerve pain is important to help improve their quality of life and improve function. Few people experience a full recovery. A decrease in pain of 30% to 50% is considered good improvement.

Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. Medications that can help patients with other diseases such as seizures ( gabapentin and pregabalin) or depression (amitriptyline, doxepin, nortriptyline, duloxetine, venlafaxine and desvenlafaxine) have been shown to help decrease nerve pain. Pain medications called opioids should be avoided in pain that isn't caused by cancer, as opioids have many side effects and can become addicting.

Topical medications, or medications that can be rubbed into or placed on the skin, including capsaicin cream and lidocaine patches, can also be used to help nerve pain. These medications should be applied multiple times each day. It’s not as convenient as a tablet one time a day but topical products may have fewer side effects.

Nonmedication treatment options

Encouragement from family, friends or support groups can address the concerns and anxieties of patients with nerve pain.

Just as it is important to check blood sugar levels, checking your feet or having someone else check them regularly is a great way to prevent a problem as well. Look between the toes and use a mirror to see the bottoms of the feet. Look for cuts, sores, calluses, blisters and ingrown toenails. Also, feel the feet for hot or cold spots, bumps or dry skin. If any problem is found, get treatment right away. Early treatment is important for preventing other, more serious issues.

Alternative treatments

Scrambler therapy is a pain management option that uses electrodes. Patches are placed on the areas around the pain, and electrodes give off "non-pain" senses that send messages to the brain to decrease pain sensations. Feelings such as pressure and itching may replace the feelings of pain.

Transcutaneous electrical nerve stimulation (TENS) is similar to scrambler therapy. Patches are placed on painful areas and electrical currents run through, altering in rhythm and strength. This type of treatment can be used for days to months.

Lifestyle remedies include keeping blood glucose levels under tight control, exercise (even if minimal weight loss has been shown), and decreasing waist circumference.

People experiencing diabetic nerve pain should speak with their healthcare providers about what treatment options would be the best for them.

Clinically reviewed and updated, March 2022.

Sources:

1. Ardeleanu V, Toma A, Pafili K, et al. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina. 2020; 26: 1-10.

2. Vinik AI, Nevoret ML, Casellini, C, et al. Diabetic Neuropathy. Endocrinol Metab Clin N Am. 2013; 42: 747-787.

3. Jha S, Sahani OP, Siddique S, et al. Effectiveness of pregabalin compared to duloxetine in diabetic peripheral neuropathic pain: an observational study. Journal of The Association of Physicians of India. 2019; 67: 32 – 36.

4. Callaghan BC, Gallagher G, Fridman V, et al. Diabetic neuropathy: what does the future hold? Diabetologia. 2020; 1-7.

5. https://www.diabetes.org/diabetes/complications/neuropathy/steps-prevent-or-delay-nerve-damage  

6. https://www.practicalpainmanagement.com/resources/news-and-research/ada-releases-new-guidelines-managing-diabetic-peripheral-neuropathy

7. Lee YS, Park MK, Park HS, et al. Scrambler therapy for the treatment of diabetic peripheral neuropathy pain. Medicine. 2019; 98: 20.

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