What Medications Work Best for Diabetic Nerve Pain?

What Medications Work Best for Diabetic Nerve Pain

You should not have to live with pain.

No one should.

Modern medical science has made so much progress in treating pain that a chronic and well-researched disease, such as diabetes, should be pain-free.

Right?

Well, the truth is a bit more complicated.

If you are combating diabetes, your main efforts (diet, medications, exercise, etc.) are probably focused on keeping the blood sugar levels stable.

This is good.

However, it will not do much to improve diabetic nerve pain.

Now, you might be asking yourself, why?

There is a simple answer.

It’s because diabetic nerve pain is a result of the damage that has already been done to your body, caused by diabetes.

Controlling the disease is absolutely necessary.

It will prevent, reduce, or slow down further damage but it will not reverse the existing one.

Luckily, there are medications that can help you to get rid of the pain or at least reduce its intensity.

You might find that these are a little bit different than your usual painkillers.

This is because your pain is caused by nerve damage, a very serious and painful condition in any of its forms.

In this article, you’ll find everything you need to know about the best drugs for diabetic nerve pain, as well as other ways to successfully manage this serious issue and increase your quality of life.

But first, let’s explain the cause of the pain.

What Causes Diabetic Nerve Pain

High blood sugar affects your nerves in two ways.

The first one is through direct damage.

By damaging the nerves it prevents them from maintaining their proper function, which is to enable normal communication between the brain and other tissues and organs.

The second way in which diabetes can affect your nerves is by damaging the blood vessels that supply them with the much-needed nutrients and oxygen.

Hungry nerves are like hungry people, not very efficient at work.

Usually, diabetic nerve pain is caused by a combination of these.

Other factors that increase the risk of pain occurrence are:

  • Obesity
  • Smoking
  • Genetic factors
  • Alcohol consumption
  • Underlying conditions (e.g. kidney disease, nerve inflammation, etc.)
  • Untreated diabetes (poorly controlled blood sugar over a longer time period)

The Symptoms

As you already know, the main symptom of diabetic nerve pain is pain, of course.

However, the type of pain and its location depend on the type of nerve damage (neuropathy).

Peripheral neuropathy causes pain in the limbs. Legs and feet are more commonly affected but arms and hands can become painful too. Main symptoms of peripheral nerve pain are:

  • Cramps
  • Joint pain
  • Bone pain
  • Sharp pain
  • Increased touch sensitivity

Diabetic amyotrophy is characterized by severe pain on one side of the body. You will usually experience pain in the hip, thigh, and buttock area.

Mononeuropathy is caused by damage to one specific nerve. This nerve can be located anywhere in your body, from face to feet. As a result, you might experience different types of pain, such as:

  • Shin pain
  • Foot pain
  • Thigh pain
  • Chest pain
  • Abdominal pain
  • Lower back pain
  • Pain behind the eye

The Best Ways to Manage Diabetic Nerve Pain

The fact that you are experiencing nerve pain means that your nerves are damaged.

Unfortunately, you cannot repair or replace damaged nerves. However, you can damage them even more.

Doesn’t seem very fair, does it?

It is just how things are right now and we have to find the way to work our way around them and manage diabetic nerve pain successfully.

These are the best ways to do it:

1.) Keep Your Diabetes in Check

If you do not want your diabetic nerve pain to become even worse, keep your diabetes in check.

Consult your doctor about the best dietary regimen and exercise program.

Maintain a healthy weight and quit smoking.

Measure your blood sugar levels regularly and take your prescribed diabetes medication therapy.

These are the best ways to control your diabetes and prevent further nerve damage.

2.) Stay Active

Low-impact physical activity, such as swimming, can have a soothing effect on nerve pain and benefit your overall health.

However, no level of physical activity can reverse the nerve damage or cure the cause of the pain.

3.) Use Medications

The first thing you should know is that there is no highly-effective way of treating diabetic nerve pain, even with the use of medications.

Don’t worry, this does not mean the pain cannot be treated.

It only means that there is no one, certain, way that can relieve the pain to everyone.

The treatment is usually personalized.

Still, medications are by far the most successful way of treating nerve pain.

The drugs commonly used in diabetic nerve pain treatment can be classified into three main categories:

What is the best medication for diabetic nerve pain?

Anti-Seizure Drugs

Anti-seizure drugs are medications originally designed to prevent epileptic seizures.

However, some of these drugs are very effective in relieving diabetic nerve pain.

The best examples of such medications are gabapentin and pregabalin.

Gabapentin, also known under brand names NeurontinGralise, and Horizant, is an anticonvulsant.

It is a medication known to interfere with certain nerves and chemicals that are responsible for the feeling of pain.

In simple words, gabapentin can block the nerve pain signals from reaching your brain.

Gralise and Horizant are the brands usually prescribed for diabetic nerve pain treatment.

They can be very effective.

If you are considering gabapentin therapy, make sure to discuss all the potential benefits, side effects, and complications with your doctor.

Some people have reported suicidal thoughts while taking this therapy, so regular doctor check-ups are advised.

Pregabalin (Lyrica, Lyrica CR) is another anti-seizure drug that works well on diabetic nerve pain.

In a similar way like gabapentin, it affects the chemicals responsible for sending pain signals throughout the nervous system.

Therefore, it is potentially very effective in treating severe pain caused by nerve damage.

People allergic to pregabalin can experience severe, and even life-threatening allergic reactions.

Breathing difficulties are the main symptom of pregabalin allergy.

They are caused by the swelling of the tongue, lips, and throat. If you experience any of these, seek medical help immediately.

Opioid Painkillers

Opioid painkillers are powerful drugs that can bring fast but short-term relief from pain.

Diabetic nerve pain is no exception. If you need to get rid of the crippling nerve pain rapidly, opioids can be a good one-time solution.

However, long-term use of opioid painkillers such as oxycodone (Oxycontin) and tramadol (Ultram) is often associated with addiction and other unwanted complications.

Tapentadol (Nucynta, Nucynta ER), is a little bit different from most opioids.

That is why it is sometimes prescribed for diabetic nerve pain treatment.

Especially in its “extended release” (ER) form, tapentadol is a powerful opioid that can bring relief from severe pain over a longer period of time.

Tapentadol should not be used “as-needed” (e.g. to treat headache).

You can only use this drug as a part of a prescribed and controlled treatment with strictly determined dosage and duration of the therapy.

Like most opioids, tapentadol can cause addiction and its misuse can result in a number of serious complications, including death.

Antidepressants

As their name suggests, antidepressants are mainly used to treat depression.

These medications affect the chemicals in your brain in various ways.

Some of them are proven to bring pain relief, by blocking the nerve pain signals.

Doctors often prescribe two types of antidepressants to treat diabetic nerve pain.

These are tricyclic antidepressants as well as selective serotonin and norepinephrine reuptake inhibitors (SSNRI’s).

Both tend to be equally effective, but SSNRI’s have less side effects.

Duloxetine (Cymbalta, Irenka) is an SSNRI antidepressant used in the treatment of diabetic nerve pain.

Duloxetine increases levels of serotonin and norepinephrine inside your body.

This causes pain signals to lose frequency and intensity. Scientists are still not sure how and why, but duloxetine definitely brings relief from painful conditions such as fibromyalgia and diabetic nerve pain.

You should not take duloxetine in combination with any other antidepressants, opioids, blood thinners, amphetamines, or migraine medicines.

Topical capsaicin creams are also used sometimes to block diabetic nerve pain.

However, their positive effect on this type of pain has not been proven by any of the studies performed so far.

The Final Word

Diabetic nerve pain is, unfortunately, a common and serious complication related to diabetes.

It is also the one that cannot be solely addressed by any method of exercise, dieting, autosuggestion, etc…

Diabetic nerve pain always requires medications therapy.

This therapy is not the same for everyone because not all people react the same to all medications.

The best thing you can do is to talk to your doctor about your specific problems and be ready to try out different treatment combinations.

Only like this you will be able to find the one that works best for you.

Expert References:

  1. Bannister K, Qu C, Navratilova E, Oyarzo J, Xie JY, King T, Dickenson AH, Porreca F. Multiple sites and actions of gabapentin-induced relief of ongoing experimental neuropathic pain. Pain. 2017 Dec;158(12):2386-2395. doi: 10.1097/j.pain.0000000000001040. PubMed PMID: 28832395; PubMed Central PMCID: PMC5681862.
  2. Azmi S, ElHadd KT, Nelson A, Chapman A, Bowling FL, Perumbalath A, Lim J, Marshall A, Malik RA, Alam U. Pregabalin in the Management of Painful Diabetic Neuropathy: A Narrative Review. Diabetes Ther. 2019 Feb;10(1):35-56. doi: 10.1007/s13300-018-0550-x. Epub 2018 Dec 18. PubMed PMID: 30565054; PubMed Central PMCID: PMC6349275.
  3. Yosuke Sugiyama, Tomoya Kataoka, Yoshihiko Tasaki, Yuki Kondo, Noriko Sato, Taku Naiki, Nobuhiro Sakamoto, Tatsuo Akechi, Kazunori Kimura, Efficacy of tapentadol for first-line opioid-resistant neuropathic pain in Japan, Japanese Journal of Clinical Oncology, Volume 48, Issue 4, April 2018, Pages 362–366, https://doi.org/10.1093/jjco/hyy023
  4. Yasuda H, Hotta N, Kasuga M, Kashiwagi A, Kawamori R, Yamada T, Baba Y, Alev L, Nakajo K. Efficacy and safety of 40 mg or 60 mg duloxetine in Japanese adults with diabetic neuropathic pain: Results from a randomized, 52-week, open-label study. J Diabetes Investig. 2016 Jan;7(1):100-8. doi: 10.1111/jdi.12361. Epub 2015 May 18. PubMed PMID: 26816607; PubMed Central PMCID: PMC4718094.
  5. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Jan 13;1(1): CD007393. doi: 10.1002/14651858.CD007393.pub4. PubMed PMID: 28085183; PubMed Central PMCID: PMC6464756.
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