How Can I Manage Pain From Diabetic Neuropathy?

Question: My wife has a problem with neuropathy in her legs from diabetes. Recently, the pain level has increased and the pain medicine hardly touches it. I have read that heavy doses of the various B vitamins along with folic acid will help. What is your opinion?

Dr. Hibberd's Answer:

Diabetic neuropathy (nerve related) pain has long been a difficult entity to treat. Years ago we had few medications other than pain relievers to treat this. Unfortunately, B vitamin supplementation with folic acid by itself has not been effective enough to treat this condition in most diabetics. Often, we will treat neuropathy in the form of a B-complex multivitamin with 2 mg of folate daily.

We have very good evidence that neuropathy severity will be reduced by aggressive control of diabetes in order to maintain as close to normal blood glucoses as possible. Once present, the pain associated with diabetic neuropathy often requires aggressive investigation and management. First, be sure this pain is not a symptom of conditions that cause reduced blood flow that can be effectively and specifically treated. Second, be sure this is diabetic neuropathy, and not a neuropathy related to other health conditions that need specific attention, such as Vitamin B12 deficiency, folic acid deficiency, inflammation, infection, malignancy, and vasculitis. Third, talk with your doctor about the possibility of using combinations of newer drugs that are known to reduce the discomfort of painful neuropathies.

Unfortunately, I am afraid they do not treat the neuropathy itself, only the discomfort associated with it. Some of the drugs commonly used are anti-depressants (older drugs such as amitriptyline or nortryptyline as well as newer SSRI's which include serotonin receptor blockers Zoloft and Prozac), anti-seizure medications (such as Neurontin), and newer agents such as Lyrica. Often anti-inflammatories are used as adjuncts to neuropathy management. Their dosage and risks of use are affected by individual health conditions and circumstances. Avoid self-treating neuropathy pain, and seek professional guidance.