Diabetic neuropathy: Treatments and drugs - MayoClinic.com

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Diabetic neuropathy: Treatments and drugs - MayoClinic.com
Jan. 16, 2008
By Mayo Clinic Staff
MayoClinic.com

Treatments and drugs

Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:

* Slowing progression of the disease
* Relieving pain
* Managing complications
* Restoring function

Slowing disease progression
Consistently keeping blood sugar within a narrow target range can help delay the progression of peripheral neuropathy and may even cause an improvement in symptoms you already have. In some people, intense glucose control may reduce the overall risk of diabetic neuropathy by more than 60 percent.

For intense blood sugar control, your goals will likely be:

* Blood sugar level before meals — 90 to 130 mg/dL (5 to 7 mmol/L)
* Blood sugar level two hours after meals — less than 180 mg/dL (10 mmol/L)
* Hemoglobin A1C, an indicator of your blood sugar control for the past few months — less than 7 percent

A1C is the amount of sugar that has bound to hemoglobin — the substance that carries oxygen inside red blood cells — in your blood. The higher your average blood sugar level for the past two or three months, the higher your A1C number will be. People who don't have diabetes have an A1C between 4 percent and 6 percent.

To help slow nerve damage:

* Follow your doctor's recommendations for good foot care
* Keep your blood pressure under control
* Follow a healthy eating plan
* Get plenty of physical activity
* Maintain a healthy weight
* Stop smoking
* Avoid alcohol entirely or, if drinking is allowed, have no more than one drink a day if you're a woman and no more than two drinks a day if you're a man.

Relieving pain
Providing effective pain relief is one of the most difficult parts of managing diabetic neuropathy. Several medications are used to relieve nerve pain, but they don't work for everyone and most have side effects that must be weighed against the benefits they offer.

Among the medications that may be tried are the following:

* Anti-seizure medications. Drugs such as gabapentin (Neurontin), pregabalin (Lyrica) and carbamazepine (Tegretol) were originally developed to treat seizure disorders (epilepsy), but they're also prescribed for nerve pain. Side effects may include drowsiness and dizziness.
* Tricyclic antidepressants. Antidepressant medications, such as amitriptyline, nortriptyline (Pamelor), desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms by interfering with chemical processes in your brain that cause you to feel pain, but they also cause a number of side effects. Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and fluoxetine hydrochloride (Prozac), have fewer side effects but work less well for pain. Newer antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs) are often a better choice, relieving pain with few side effects.
* Lidocaine patch. This patch contains the topical anesthetic lidocaine. You apply it to the area where your pain is most severe. It has almost no side effects, although it may cause a rash in some people.
* Capsaicin. This is the chemical that gives hot peppers their bite. When applied to the skin, capsaicin creams (ArthriCare, Zostrix, others) can reduce pain sensations in some people.
* Other medications. Opioid analgesics, such as codeine or oxycodone (OxyContin) may be used to relieve pain. But this class of medications may produce serious side effects, including addiction, that make long-term use of them undesirable.

Other types of therapy
Several drug-free therapies and techniques also may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own. They include:

* Alpha-lipoic acid (ALA). One of the most interesting developments in pain research is the discovery that alpha-lipoic acid, a powerful antioxidant found in food, may be effective at relieving the symptoms of peripheral neuropathy. Studies used an intravenous form of ALA, which isn't yet available, however, and researchers caution that it's not known whether over-the-counter supplements have the same effect.
* Transcutaneous electrical nerve stimulation (TENS). Your doctor may prescribe this therapy, which can help prevent pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Although safe and painless, TENS doesn't work for everyone or for all types of pain.
* Biofeedback. This therapy uses a special machine to teach you how to control certain body responses that reduce pain. You then learn how to control these same responses yourself. Biofeedback techniques are often taught in medical centers and hospitals.
* Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for chronic pain, possibly including the pain of neuropathy. Keep in mind that you may not get immediate relief with acupuncture and will likely require more than one session.
* Hypnosis. Many adults can be hypnotized by a trained professional, but for hypnosis to be most effective, you also have to be a willing and motivated participant. During hypnosis, you'll typically receive suggestions intended to decrease your perception of pain.
* Relaxation techniques. Designed to help reduce the muscle tension that makes pain worse, relaxation techniques range from deep-breathing exercises to visualization (imagining yourself floating in a tropical ocean, for example), yoga and meditation. You might want to take classes in one or more of these techniques, or you can learn them yourself using books or tapes.

Managing complications
Specific treatments exist for many of the complications of neuropathy, including:

* Urinary tract problems. Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings inserted into the vagina to prevent urine leakage — may be helpful in treating loss of bladder control. Often, a combination of therapies may be most effective.
* Digestive problems. Gastroparesis can usually be helped by eating smaller, more frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Diarrhea, constipation and nausea may be helped with dietary changes and medications.
* Low blood pressure on standing (orthostatic hypertension). This is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water and standing up slowly. Several medications, either alone or together, also may be used to treat orthostatic hypotension. For example, the drug fludrocortisone helps boost your blood volume, which in turn raises blood pressure.
* Sexual dysfunction. Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) can improve sexual function in some men, but these medications aren't effective or safe for everyone. When medications don't work, many men turn to vacuum devices, or, if these fail, to penile implants. Women may be helped with vaginal lubricants and estrogen creams.

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