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Treating Painful Diabetic Peripheral Neuropathy
By Christine Dobrowolski, DPM

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, runner, and author of "Those Aching Feet: Your Guide To Diagnosis and Treatment of Common Foot Problems," available via her publisher, SKI Publishing, and at Barnes & Noble and Amazon.com.


Articles by Dr. Christine Dobrowolski, DPM