Diabetes can cause long-term problems throughout your body, especially if you don’t control your blood sugar effectively, and sugar levels remain high for many years. High blood sugar can cause diabetic neuropathy, which damages the nerves that send signals from your hands and feet.
Diabetic neuropathy can cause numbness or tingling in your fingers, toes, hands, and feet. Another symptom is a burning, sharp, or aching pain (diabetic nerve pain). The pain may be mild at first, but it can get worse over time and spread up your legs or arms. Walking can be painful and even the softest touch can feel unbearable.
Ten to 20 percent of people with diabetes experience nerve pain. Nerve damage can affect your ability to sleep, decrease your quality of life, and can also cause depression.
Damaged nerves can’t be replaced. However, there are ways that you can prevent further damage and relieve your pain.
First, control your blood sugar so the damage doesn’t progress. Talk to your doctor about setting your blood sugar goal, and learn to monitor it. You may be asked to lower your blood sugar before meals to 70 to 130 mg/dL and your blood sugar after meals to less than 180 mg/dL.
Use diets, exercise, and medications to decrease your blood sugar to a healthier range. Monitor other health risks that can worsen your diabetes, such as your weight and smoking. Ask your doctor about effective ways to lose weight or quit smoking, if necessary.
Your doctor might suggest trying an over-the-counter pain reliever, such as acetaminophen (Tylenol), aspirin, or ibuprofen (Motrin, Advil), which are available without a prescription but can cause side effects. Use a low dose for a short time to control your symptoms.
Other options exist for stronger or longer term pain relief.
Antidepressants most commonly treat depression. However, they can be prescribed for diabetic nerve pain because they interfere with chemicals in your brain that cause you to feel pain. Your doctor may recommend tricyclic antidepressants, such as amitriptyline (Elavil), imipramine (Tofranil), and desipramine (Norpramin). These can cause unpleasant side effects like dry mouth, fatigue, and sweating. Your doctor may refrain from recommending tricyclic antidepressants if you have a history of heart problems.
Serotonin and norepinephrine reuptake inhibitors (SNRI) like venlafaxine (Effexor) and duloxetine (Cymbalta) are an alternative to tricyclics and tend to have fewer side effects.
Powerful drugs like oxycodone (Oxycontin) and the opioid-like medicine tramadol (Conzip, Ultram) can treat much stronger pain. But these tend to be a last resort for pain relief. You might use these medications if other treatments aren’t working. However, these drugs are not meant for long-term relief because of side effects and the potential for addiction. Work closely with your doctor and use caution when taking opioid medicines.
Lidocaine patches deliver local anesthetic through a patch placed on the skin, and can also cause minor skin irritation.
Drugs used to prevent epileptic seizures can also help with nerve pain. These drugs include pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), phenytoin (Dilantin), and carbamazepine (Carbatrol, Tegretol). Pregabalin can also improve your sleep. Side effects include drowsiness, swelling, and dizziness.
A few alternative (although unproven) therapies have been studied for diabetic nerve pain, including:
Some physical therapy treatments, such as swimming, can help treat diabetic neuropathy. Low-impact exercises are the most effective, as high-impact exercises can quickly cause nerves to go numb.
Be sure to choose a trusted physical therapist who understands neuropathy, diabetic or otherwise, to help you work through physical therapy methods in order to prevent further nerve damage. Proper attention to physical activity by an expert can prevent any further issues from occurring. Keep in mind, too, that physical therapy can soothe diabetic nerve pain, but not cure it.
Capsaicin cream (Arthricare, Zostrix) can block pain signals using an ingredient found in hot peppers. Capsaicin products cause skin irritation in some people. Capsaicin cream, which is also available as a lotion, jelly, or patch, can be applied to the skin where diabetic nerve pain is strong and temporarily relieve pain.
Talk to your doctor before using treatments based on capsaicin. It can cause allergic reactions, interact with other drugs, or cause dangerous side effects on open sores and irritated or sensitive skin. You might also be more sensitive to the sun and other sources of heat. Avoid excessive exposure to sunlight or heat when using capsaicin creams or lotions.
Diabetic nerve damage causes pain and can also affect your ability to feel pain, so it’s important to maintain your foot health.
To take better care of your feet, check your feet every day for cuts, sores, swelling, and other problems, even if you don’t feel any problems. They can get infected, and untreated infections can lead to serious complications, including amputation.
Wash your feet daily with warm water and dry them completely afterward. Then apply a lotion to keep them moisturized. Avoid getting lotion in between your toes.
Wear comfortable, flexible shoes that give your feet room to move. Break in new shoes slowly so that they don’t hurt your feet. Ask your doctor about customized shoes if regular shoes don’t fit well.
Always cover your feet with shoes, slippers, or thick socks to cushion them and prevent injuries.
Keeping your blood sugar under control to prevent nerve damage is the best way to avoid nerve pain. Follow your doctor’s advice for diet, exercise, and treatments if you already experience diabetic nerve pain. Diabetic neuropathy does not have any known cures. However, many treatments can help lessen the discomfort and pain caused by diabetic nerve pain, and your doctor can assist you in selecting one that works best for you.