Peripheral neuropathy is a long-term complication of diabetes, both type 1 and type 2. It's caused by prolonged exposure to excessive blood glucose levels and affects the nerves of the extremities, most commonly the feet and lower legs. The longer a person has diabetes, the greater the risk of painful neuropathy.
Symptoms of neuropathy include numbness, tingling or prickly feelings, usually in the feet. As it advances, intense burning pain can become an issue. What do doctors prescribe for pain and how do these medicines work? And more importantly, are they successful at treating neuropathic pain?
Acetaminophen or NSAIDs
- Acetaminophen or other over-the-counter anti-inflammatories such as ibuprofen or naproxen may be recommended. These are called NSAIDs, or non-steroidal anti-inflammatory drugs. They may work against the pain, but some NSAIDs carry the risk of decreased kidney function in people with diabetes if taken for an extended amount of time.
Tricyclic Antidepressants (TCAs)
- TCAs can be effective at treating neuropathic pain. Although they are classified as antidepressants, their pain relieving properties can typically be felt at much lower doses than what is prescribed to a person with depression.
Common TCAs prescribed for neuropathy include: Imipramine (Tofranil), amitriptyline (Elavil), and nortriptyline (Pamelor, Aventyl). Elavil is currently the most commonly prescribed antidepressant medication prescribed for peripheral neuropathy.
Selective Serotonin Reuptake Inhibitors (SSRIs)
- SSRIs are another class of antidepressant that also treat anxiety. They work like TCAs, in that at lower doses they are effective for neuropathic pain. They seem to be better tolerated and the side effects are generally fewer than TCAs, but the downside is that sometimes they are not as effective.
- The newest SSRI on the market is Cymbalta (duloxetine hcl). It is both a serotonin and norephinephrine reuptake inhibitor, which scientists feel offers better pain control. Other single-action SSRIs include citalopram (Celexa), escitalopram oxalate (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
Anticonvulsants
- These medications work by stabilizing damaged nerves and easing the pain signals that they send to the brain. Popular anticonvulsants that are approved for diabetic peripheral neuropathy include: gabapentin (Neurontin) and pregabalin (Lyrica)
Narcotics/opioids
- Narcotics are not usually the first type of medication prescribed for diabetic neuropathy, but they can be useful when the pain does not respond to anything else.
- Common opioids prescribed for moderate to severe pain include: oxycodone (OxyContin, Percoset) and fentynal (available in the Duragesic patch).
- Many doctors and patients are concerned about the stigma of addiction and only consider opioids as a pain control option when nothing else has worked.
Also, research is underway to find other possible pain treatments, such as:
- Methylcobalamin: a form of Vitamin B-12, commonly used with success in cats, is currently being studied. Methylcobalamin 	
- Methadone: There have been promising trial results for controlling severe neuropathic pain with methadone. It is currently used for chronic pain in the areas of palliative care, and for cancer pain. It's less sedating than other opioids, and relatively inexpensive to purchase.
Methadone Studies
Finding pain relief for diabetic peripheral neuropathy can be challenging because there is no specific drug that works for all people. Very often, a patient and doctor must try many different kinds and combinations of pain medications until acceptable pain relief is reached.
SOURCES:
Peripheral Neuropathy. Retrieved 10/11/06, from American Diabetes Association Web site: ADA's Peripheral Neuropathy
Hays, MD, Lewis, Reid, MD, Coleen, Doran, APRN, BC-PCM , Michelle, & Geary, APRN, BC-PCM, Karyn (2005). Use of Methadone for the Treatment of Diabetic Neuropathy. Diabetes Care Online, 28:485-487, Retrieved: 10/11/06, from Use of Methadone.
|
