Managing nerve pain in diabetes
Resident Pharmacist
Walgreens and Midwestern University
What is diabetic nerve pain?
Diabetic nerve pain is pain that is caused by having high blood-sugar levels that are not under control.1 This is also known as diabetic neuropathy, a type of nerve damage that typically affects the legs and feet. When the nerves are injured, it may cause painful symptoms or no symptoms at all.2
Peripheral neuropathy is the most common type of nerve pain found in people with diabetes, affecting 30-60% of the diabetic population.3 Pain occurs first in the feet and legs, and can be followed by the arms and hands if sugar levels are not kept under control.2 Symptoms of peripheral neuropathy usually get worse at nighttime.2
Typical symptoms might include:2
- Numbness or decreased ability to feel pain or temperature changes
- Tingling or burning
- Sharp pain or cramps
Serious foot problems (including ulcers, infections, bone pain, joint pain)
Risk factors of diabetic nerve pain are having blood sugars that are not controlled, being overweight or obese, and having a large waist circumference.4 Complications, if not controlled, include worsening diabetic nerve pain that can turn into more serious problems like foot cuts or sores that do not heal –possibly resulting in amputation.2
Can nerve pain be reversed in diabetes?
Prevention and slowing progression of nerve damage
Living with diabetes can be managed in different ways. Some people test their blood sugar levels many times throughout the day, allowing a person to see how certain foods or habits can change their blood sugar. Other people, usually those taking insulin, count carbohydrates in order to know how much insulin they should use to control their sugars.
By being aware of blood sugar levels and keeping them under control, people living with diabetes can help themselves have a lower risk for complications like diabetic nerve pain. There are two ways for people to keep track of their blood sugar:5
Use a blood glucose meter and test strips to test sugar levels one or more times a day. Keeping a written record of this to show the doctor is helpful; this would help a doctor easily change medication correctly if sugar levels are not being controlled.5
- Get an A1c test done at the doctor's office or lab every 3-6 months. This test provides the average blood sugar level over the last 3 months.5
Exercise and weight loss are other ways people living with diabetes can help lower their risk of getting diabetic nerve pain or help decrease the pain if they already have it.4 It's important to remember that these are all helpful to decrease nerve damage and pain, but they may not completely take away all the pain. It's important to always keep blood sugar levels under control –which helps keep the risk of damaging the nerves low.
Treatment
Finding the right medication or treatment for someone with nerve pain is important to help improve their quality of life and improve function.4 Few people experience a full recovery, but a decrease in pain of 30-50% should be considered good improvement.4
Some of the first treatment options for nerve pain are medications known to treat other diseases as well.5 Medications that can help patients with seizures or depression have also been shown to help decrease nerve pain. (Pain medications called opioids should be avoided in pain that isn't caused by cancer as opioids have many side effects and can become addicting.6)
Topical medications, or medications that can be rubbed into or placed on the skin, can be used to help nerve pain also. These medications should be applied multiple times each day, which is not as convenient as a tablet one time a day, but may have less side effects.
Non-medication treatment options
Encouragement from family, friends or support groups can address the concerns and anxieties of patients with nerve pain. This support is essential for a person's successful management of diabetic nerve pain.2
Just as it is important to check blood sugar levels, (having a person for) checking peoples' feet every day is a great way to prevent a problem as well. Look between the toes and use a mirror to see the bottom of the feett. Look for cuts, sores, calluses, blisters and ingrown toenails. Also, feel the feet for hot or cold spots or bumps or dry skin. If any problem found, get treatment right away. Early treatment is important for preventing other more serious issues.5
Alternative medicines
Scrambler therapy7 is a pain management option that uses electrodes. Patches are placed on the areas around the pain, and electrodes give off "non-pain" senses that send messages to the brain to decrease pain sensations. Feelings such as pressure and itching may replace the feelings of pain.7
Transcutaneous electrical nerve stimulation (TENS)7 is similar to scrambler therapy. Patches are placed on painful areas, and electrical currents run through, altering in rhythm and strength. This type of treatment can be used for days to months.
Lifestyle remedies include keeping blood glucose levels under tight control, exercise (even if minimal weight loss has been shown), and decreasing waist circumference.4
People experiencing this kind of pain should speak with their healthcare providers about what treatment options would be the best for them.5
Published on May 25, 2020
References
1. Ardeleanu V, Toma A, Pafili K, et al. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina. 2020; 26: 1-10.
2. Vinik AI, Nevoret ML, Casellini, C, et al. Diabetic Neuropathy. Endocrinol Metab Clin N Am. 2013; 42: 747-787.
3. Jha S, Sahani OP, Siddique S, et al. Effectiveness of pregabalin compared to duloxetine in diabetic peripheral neuropathic pain: an observational study. Journal of The Association of Physicians of India. 2019; 67: 32 – 36.
4. Callaghan BC, Gallagher G, Fridman V, et al. Diabetic neuropathy: what does the future hold? Diabetologia. 2020; 1-7.
5. American Diabetes Association. Steps to prevent or delay nerve damage. https://www.diabetes.org/diabetes/complications/neuropathy/steps-prevent-or-delay-nerve-damage (accessed 2020 Feb 15).
6. American Diabetes Association. ADA releases new guidelines on managing diabetic peripheral neuropathy. https://www.practicalpainmanagement.com/resources/news-and-research/ada-releases-new-guidelines-managing-diabetic-peripheral-neuropathy (accessed 2020 Feb 15).
7. Lee YS, Park MK, Park HS, et al. Scrambler therapy for the treatment of diabetic peripheral neuropathy pain. Medicine. 2019; 98: 20.