Prescription Drugs for Diabetes Nerve Pain continued...
Antiseizure drugs. Drugs that prevent epileptic seizures can also relieve certain pain conditions, including neuropathy. "The majority of pain patients can be treated with any of these," says Gibbons. The drugs work by controlling the abnormal firing of nerve cells - in the brain and in other parts of the body, like legs and arms, he explains.
- Neurontin is the antiseizure drug most commonly used for nerve pain from peripheral neuropathy. "It's quite effective in treatment of painful neuropathy," says Gibbons. "It does tend to cause sedation or dizziness at higher doses. But if the dosage is increased slowly, it is quite well tolerated."
- Lyrica is a seizure medication that is FDA-approved for painful neuropathy. "It is designed as the next generation of Neurontin," says Gibbons. The most common side effects are dizziness and sleepiness.
Opioid medicines. When pain is very severe, patients want immediate relief, says Gibbons. That's when they may need to see a pain specialist. Sometimes people need strong painkillers called Ultram or Ultracet, possibly in combination with Neurontin. "The combination gets people past that acute stage of pain while I can slowly increase the Neurontin."
Both Ultram and Ultracet are FDA-approved painkillers that contain tramadol, a weak opioid (morphine-like) substance. The drug also weakly affects the brain chemicals serotonin and norepinephrine, similar to antidepressants, which reduces the perception of pain.
"Often we use tramadol as a back-up for what we call 'breakthrough pain' - pain that suddenly, for no apparent reason, is worse at times," says Gibbons. Tramadol is a good replacement for over-the-counter stuff at those times."
Neuropathy specialists shy away from strong narcotic opioid medications, he notes. Narcotics can cause severe constipation, and there is the potential for addiction. "There's also a stigma about using a narcotic drug," he says. "Depending on the type of work a person does, it could be a problem."
More Treatment Options for Diabetes Nerve Pain
For severe, intractable diabetes nerve pain, injections of local anesthetics such as lidocaine - or patches containing lidocaine - are used to numb the painful area.
Doctors can also:
- Surgically destroy nerves or relieve a nerve compression that causes pain.
- Implant a device that relieves pain.
- Perform electrical nerve stimulation which may relieve pain. In this treatment, small amounts of electricity are used to block pain signals as they pass through the skin. "It's debatable whether this is effective," says Gibbons.
Other useful aides to improve quality of life and function include:
- Hand or foot braces can compensate for muscle weakness or help relieve nerve compression.
- Orthopaedic shoes can improve gait (walking) problems, which will prevent foot injuries.