Medication for Diabetic Neuropathy – DIABETIC SOCK CLUB

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Medication for Diabetic Neuropathy

High blood sugar levels associated with diabetes can cause nerve damage. This nerve damage can lead to burning pain, weakness, numbness, and paresthesia (this term refers to the feeling of burning or prickling sensation in the legs and feet). When nerves are damaged, diabetic neuropathy can develop. 


About 50% of diabetic patients tend to develop diabetic neuropathy. Neuropathy is a chronic and progressive condition, but fortunately, this condition can be managed with medication and lifestyle changes. There are four main types of diabetic neuropathy, and these are:


  • Peripheral Neuropathy - Most typical for people with diabetes to develop this type of neuropathy. Peripheral neuropathy damages the nerves located outside the brain and spinal cord. This often causes weakness, numbness, and pain, and the affected parts are usually the hands and feet. It can sometimes affect other areas and body functions, including digestion, urination, and circulation.

  • Autonomic neuropathy - refers to damage to the nerves that serve your internal organs. These organs help carry out functions like digestion, sweating, and urination. Autonomic nerves control largely involuntary functions of the body performed by the bladder, intestinal tract, and genitals, among other organs. If you have this type of neuropathy, you can also develop other health conditions such as; Digestion problems, Cardiovascular problems, and Sexual and bladder problems.

  • Proximal neuropathy - This is a rare and disabling type of neuropathy, and it involves nerve damage in the hip, buttock, or thigh. It can cause severe pain and muscle shrinkage in the affected area. This type of nerve damage typically affects one side of your body and may rarely spread to the other side. It is more common for men to have it than women and more common in people older than the age of 50.

  • Focal neuropathy - Also called mononeuropathy, it involves damage to a single nerve that happens mostly in your hand, head, torso, or leg. It is less common than peripheral and autonomic neuropathy. Carpal tunnel syndrome and Bell's palsy are examples of focal neuropathy.

Diagnosis


Your healthcare provider can diagnose whether you have neuropathy or not by asking about your symptoms, what things you are feeling lately or what changes you have been noticing in your body and medical history. You will also have a physical examination and check your level of sensitivity to temperature and touch, your heart rate, blood pressure, and muscle tone. This will help your doctor find out and have a better view of the condition of your body. Your healthcare provider usually checks your:


  • Overall muscle strength and tone
  • Tendon reflexes
  • Sensitivity to touch, pain, temperature, and vibration

Along with a physical exam, your healthcare provider may perform or order specific tests to help diagnose diabetic neuropathy. Some of these tests include:


  • Filament testing - There is the equipment used when doing this test and it's called monofilament. It's a small strand of nylon attached to a plastic base. This test is done to check for loss of feeling in your feet.

  • Sensory testing - This test is done to tell how your nerves respond to vibration and changes in temperature.

  • Nerve conduction testing - This test is done to measure how quickly the nerves in your arms and legs conduct electrical signals.

  • Electromyography - Also called needle testing measures electrical discharges produced in your muscles.

  • Autonomic testing - A variety of tests may be performed to see how your blood pressure changes in different situations and whether your sweating is within normal limits.

Medication for Diabetic Neuropathy


It is important that you manage your blood sugar level and keep your body healthy by staying active and keeping a healthy diet but, most importantly, taking medications to help relieve and alleviate the symptoms of neuropathy. Medications are used to control the pain associated with diabetic neuropathy. There are many medications for diabetic neuropathy, and it is important that you talk to your doctor to figure out what medications will best suit your condition and is best for you. 


Over-the-counter (OTC) medications - It is always best that you consult your health care provider first before taking any OTC drugs because of the possible interactions and side effects. It is particularly important when you have diabetes because taking OTC medications may have interactions with other medications you're using and cause negative effects on your body. For diabetic neuropathy, you may want to try the following OTC medications:


  • Acetaminophen - This is a pain killer medicine also known as an analgesic. Tylenol is one example of acetaminophen, and it is the #1 doctor-recommended pain relief brand for patients with diabetes. This medication works by blocking pain signals or messages to your brain. In a way, acetaminophen makes it harder for the pain to travel through the nerves and to the brain. That way, the brain won't know that it should be feeling pain. 

Possible side effects: Liver damage (can happen when taking large quantities for a long period of time)


  • Non-steroidal anti-inflammatory drugs (NSAIDs) - Some common examples of this medicine are Advil, Aleve, and Motrin. NSAIDs have double effects, and they can work as painkillers and as an anti-inflammatory medicine. NSAIDs work by blocking the body from creating prostaglandins, which are chemicals that cause inflammation and pain. When taking NSAIDs, you prevent your body from making as many prostaglandins. That way, it decreases inflammation and pain.

Possible side effects: Stomach ulcers, diarrhea, nausea, and fatigue


  • Topical Medication - These are medications that you apply directly to your skin, and one option and an example of topical medication is "capsaicin cream" Capsaicin is what makes chili peppers hot, and it can also help to relieve pain. It just temporarily reduces the pain in the affected area, so you'll need to keep reapplying. These types of topical medication are usually used by people who have foot problems, particularly neuropathy.

Prescription medications for Diabetic Neuropathy


Most people who suffer from diabetic neuropathy need much stronger medications to relieve nerve pain. You may need a combination of various prescription medications to deal with the various effects of nerve damage. According to practical pain management, the FDA has approved three medications for diabetic neuropathy; these medications are Cymbalta, Lyrica, and Nucynta. Duloxetine, sold under the brand name Cymbalta is used to treat depression and anxiety. In addition to that, it is also used to help relieve nerve pain. Pregabalin is sold under the brand name Lyrica. This is used to treat pain caused by nerve damage due to diabetes, shingles (herpes zoster) infection, or spinal cord injury. Tapentadol, under the brand name Nucynta, is a strong prescription pain medicine that contains an opioid and is also used to manage pain from damaged nerves. Talk to your doctor first and find out if these medications are fit for you. However, there are also other medications that are commonly used successfully to treat diabetic neuropathy.


  1. Anti-depressants - Anti-depressants are used for other health conditions, not only depression. These medications work by blocking pain messages on their way to the brain, and it's also thought that anti-depressants stimulate the release of endorphins, which are the body's natural painkillers. There are several types of anti-depressants that you can check out if you have neuropathic pain. Anti-seizure medications can slow down the nerve signals going to your brain, which means that the pain message isn't transmitted as well.

  •  Tricyclic anti-depressants - By raising levels of calming neurotransmitters in your brain, tricyclic anti-depressants can, most importantly, reduce pain. They can also improve your mood and can also help if you are having a hard time sleeping (it can be difficult to sleep when you have nerve pain). For diabetic nerve pain, amitriptyline (Elavil, Tryptanol), desipramine (Norpramin and Pertofrane), and imipramine (Antideprin and Deprinol) are commonly prescribed. They're called "first line" medications because they are among the first medications doctors will try to relieve neuropathy because they are usually effective and safe.

Possible side effects: dizziness, drowsiness, dry mouth and eyes, and constipation


  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) - Doctors commonly prescribe the SNRI duloxetine (Cymbalta) to treat diabetic neuropathy. These anti-depressants increase how much serotonin and norepinephrine you have in your system. They work by blocking them from being reabsorbed by brain cells; they inhibit their reuptake. With more serotonin and norepinephrine, you should have better mental balance and reduced pain.

Possible side effects: dizziness, drowsiness, and insomnia


  • Selective serotonin reuptake inhibitors (SSRIs) - SSRIs increase how much serotonin you have. They are different from SNRIs because they only focus on the serotonin in your body. These medications work by blocking the serotonin reuptake so that your serotonin level is increased. If you have more serotonin, you have less pain perception. Some examples of SSRIs are paroxetine (Paxil) and citalopram (Celexa).

Sometimes an antidepressant may be combined with an anti-seizure drug. These drugs can also be used with pain-relieving medication, such as medication available without a prescription. For example, you may find relief from acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), or a skin patch with lidocaine (a numbing substance). But before taking the type of medications, you should first consult your doctor.


  1. Anti-seizures (also called anti-convulsants or anti-epileptics) - Anti-seizure medications on neuropathy work by slowing down the nerve signals going to your brain, which means that the pain message isn't transmitted as well. Here are some examples of anti-seizure medications.

  • Lyrica (pregabalin) - Lyrica is the first-line treatment for diabetic neuropathy, and it is an FDA-approved medication. Lyrica inhibits the neurotransmitter gamma-aminobutyric acid (GABA), which is involved in nerve pain, but its exact mechanism of action is not yet completely clear.

  • Trileptal (oxcarbazepine) - While Trileptal has been used in the treatment of diabetic neuropathy, there is little evidence of its effectiveness.

  • Topamax (topiramate) - Topamax works by blocking sodium channels that open and close in response to specific levels of charged chemicals and promote nerve pain. It is a good alternative to nerve-pain medications if you are experiencing side effects or cannot tolerate them.

Possible side effects: drowsiness, weight gain, dizziness, and nausea


  1. Opioids (Narcotics) - Opioids are very strong analgesics. They can be used to provide immediate relief for severe pain, but they can be addictive. That is why you must use them under your doctor's supervision and be cautious in using them. The best example of an opioid is Tramadol (Ultram or Ultracet), and other examples are tapentadol (Nucynta) and Oxycodone (OxyContin), which have been proven to help with neuropathic pain.

Possible side effects: drowsiness, nausea, and constipation


  1. Topical Medication - In addition to capsaicin cream, which is available without a prescription, you can also use another topical medication which is a lidocaine patch. You must have a prescription to use a lidocaine patch. Lidoderm is an example of a lidocaine patch.

Besides medication, there are other things that could be done to treat or slow the progression of neuropathy and relieve nerve pain. Complementary and alternative medicine (CAM) may help you find nerve pain relief; acupuncture is an example of an alternative treatment. Magnetic therapy, laser (light) therapy, or nerve stimulation may provide pain relief.


  • TENS Machine - In 2012, the FDA approved a non-medication treatment for diabetic neuropathy—the Sensus Pain Management device. A TENS is a small machine that is connected to a series of electrodes, which are put on your skin to deliver a low-voltage electrical charge. The electrical pulses stimulate nerve fibers in the area where you have pain and reduce the pain signals to your brain. The electrical charge may also cause your body to release natural hormones that decrease your pain levels. The device uses low-frequency electric impulses through the body (transcutaneous electrical nerve stimulation) to help improve circulation and nerve damage.

  • Electroacupuncture - Research has shown that manual acupuncture and electroacupuncture affect not only the nerve fibers of the human body but also the biochemical composition of the brain. Electrical stimulation acupuncture may be beneficial for peripheral neuropathy by producing significant analgesia. Even a study showed that patients with painful diabetic peripheral neuropathy who received electroacupuncture treatments twice a week for eight weeks had significantly greater improvements in pain and improved sleep interference.

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