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Treating the Nerve Damage from Diabetes

Summary & Participants

Treating nerve damage from diabetes requires a two-pronged approach: controlling blood sugar and alleviating the pain caused by peripheral neuropathy. Learn about the latest therapies.

Medically Reviewed On: July 21, 2008

Webcast Transcript

ROY FREEMAN, MD: For the treatment of neuropathic pain, it is unfortunate that the standard analgesics, the over-the-counter, non-steroidal anti-inflammatory drugs are not effective. Ibuprofen, naproxen do not work effectively to treat neuropathic pain. Fortunately, over the past ten, fifteen years, we've realized that a number of non-traditional analgesic agents work to treat neuropathic pain quite effectively.

Perhaps the group of agents which have the longest track record in the treatment of neuropathic pain are the tricyclic anti-depressants, drugs like amitriptyline, desipramine, nortriptyline and these are quite effective in the treatment of neuropathic pain. Unfortunately, they have an array of side effects that renders them intolerable to many patients. Older patients will often become drowsy and confused on these drugs. They may cause urinary retention and constipation. And while they are effective, the constellation of side effects that's associated with their use often minimizes our ability to use these drugs.

In addition to the anti-depressants, the anti-convulsants have been used to treat neuropathic pain. These are moderately effective.

ANNOUNCER: Opioids such as oxycodone and morphine are another category of medications that may be prescribed to relieve painful DPN. However, they are not first line treatment options and must be used with extreme caution.

ROY FREEMAN, MD: The opioids do have a role to play in the treatment of neuropathic pain. Obviously, there is concern when using any drug that has potential for abuse, potential for addiction, but these are agents that may be used as supplementary agents in combination with either an anti-depressant, or an anti-convulsant, or both to treat neuropathic pain.

ANNOUNCER: Recently, there have been two new drugs approved by the FDA to treat neuropathic pain.

ROY FREEMAN, MD: These are the first two drugs that have been approved by the FDA for the treatment of neuropathic pain, the anti-depressant duloxetine and the anti-convulsant pregabalin.

ANNOUNCER: Duloxetine is an anti-depressant which is somewhat different than the tricyclics. It has a better side effect profile and the onset of action is faster. Pregabalin is an anti-convulsant and also has a faster onset of clinical effects when compared to older agents.

In addition to oral medications, there are two topical agents that have been used in the treatment of neuropathic pain with varying results: lidocaine cream and capsaicin cream.

There are also a few mechanical devices that may be helpful to some patients.

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