Diabetic Neuropathy:Treatment & Medication

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Diabetic Neuropathy: Treatment & Medication
Dianna Quan, MD,
emedicine

Medical Care

Throughout this discussion on treatment, distinction is made between therapies for symptomatic relief and those that may slow the progression of neuropathy.

General aspects of treatment:

Consider any patient with clinical evidence of diabetic peripheral neuropathy to be at risk for foot ulceration and provide education on foot care.18 If necessary, a podiatry referral should be provided.

Patients with diabetic peripheral neuropathy require more frequent follow-up, with particular attention to foot inspection to reinforce the need for regular self-care. The provision of regular foot examinations and reinforcement of the educational message on foot care have been shown in several studies to have a major impact on rates of ulceration and even amputation.19

Current treatments for pain:

Of all treatments, tight and stable glycemic control is probably the most important for slowing the progression of neuropathy.20 Because rapid swings from hypoglycemia to hyperglycemia have been suggested to aggravate and induce neuropathic pain, the stability of glycemic control may be as important as the actual level of control in relieving neuropathic pain. The DCCT demonstrated that tight blood sugar control in patients with type 1 diabetes decreased the risk of neuropathy by 60% in 5 years.2 The effect of tight glycemic control on polyneuropathy in patients with type 2 diabetes or those with impaired glucose tolerance/impaired fasting glucose is not as clear and requires further prospective study.

Many medications are available for the treatment of diabetic neuropathic pain. These include tricyclic antidepressants, gabapentin, pregabalin, duloxetine, topical lidocaine, and capsaicin. Other medications such as carbamazepine, oxcarbazepine, phenytoin, lamotrigine, and opioids may also be used. Topical therapy with capsaicin or lidocaine patches may be useful in some patients, especially those with more localized pain or those in whom interactions with existing oral medications is a concern. Any of these medications may be associated with side effects, and patients should be counseled about possible problems before initiating treatment.21

Alternative and complementary therapies for pain (eg, acupuncture) are under investigation.



The pharmacologic agents listed below are used for the symptomatic treatment of diabetic neuropathy.

For related CME, see Medscape's CME Activity Treatment With Pregabalin May Reduce Pain of Diabetic Neuropathy.
Tricyclic antidepressants

This complex group of drugs has central and peripheral anticholinergic effects as well as sedative effects. They have central effects on pain transmission. They also block the active reuptake of norepinephrine and serotonin.

Amitriptyline (Elavil)

By inhibiting reuptake of serotonin and/or norepinephrine by presynaptic neuronal m Copyright© 1994-2009 by Medscape.embrane, may increase synaptic concentration in CNS. Useful as analgesic for certain types of chronic and neuropathic pain.

1994-2009 by Medscape.