Creams, Gels, and Oils
For mild symptoms of diabetic nerve pain, topical creams and gels -- meaning you apply them directly to your skin where it hurts -- may bring you relief.
- Capsaicin. Capzasin-P and Zostrix (capsaicin) made from crushed chili peppers, comes in a cream or roll-on form. It works by depleting nerve endings that pass chemicals from one nerve to another to transmit pain signals, Trence says. "You have to apply it four to five times a day," she says, "and it takes a couple of weeks to be effective." One risk: it may interfere with wound healing, which is often a problem for people with diabetes.
- Lidocaine. This topical anesthetic numbs the area where it's applied. You can find lidocaine in nonprescription cream or gel form (lidoderm) or in a prescription-strength patch or injection to relieve pain.
- Other creams. Drugstore creams that contain mentol as an active ingredient haven't been proven to relieve diabetic neuropathy. The same goes for creams containing cortisone; while it may work for other kinds of pain, cortisone hasn't been proven effective for diabetic nerve pain. Remember to take these drugs as directed.
For chronic disabling pain, botanical oil blends may provide rapid, temporary relief.
- Botanical extracts. A blend of botanical extracts, such as Neuragen, may provide rapid relief of neuropathic pain.
Diabetic Nerve Pain: Prescription Relief
- NSAIDs (nonsteroidal anti-inflammatory drugs). Common brands of prescription-strength NSAIDs include Celebrex, Lodine, and Relafen. The risks with taking these drugs are similar to taking over-the-counter NSAIDs, although there's an added risk of heart problems.
- Antiseizure drugs. First created to prevent the chaotic firing of nerves in seizures, drugs such as Neurontin and Lyrica are now known to have anesthetic qualities. "They help people deal with pain," says Trence, and may also help people deal with depression that can accompany the disability associated with painful neuropathy." A similar drug, Cymbalta, used for depression and approved for use in neuropathy, may help with the pain threshold issue, says Trence.
Antidepressants. It may sound curious, but antidepressants can help relieve diabetic nerve pain, and doctors sometimes prescribe them to treat nerve pain whether you're clinically depressed or not. And since depression is a common reaction to chronic nerve pain, an antidepressant can bring a double benefit by relieving both depression and pain.
- SSRIs (selective serotonin reuptake inhibitors), such as Paxil or Prozac, may work by increasing the level of a "feel-good" neurotransmitter called serotonin. SSRIs are more effective for depression than for pain, and they may be a good choice to treat both depression and nerve pain.
- SNRIs (serotonin and norepinephrine reuptake inhibitors), such as Cymbalta or Effexor, work by changing the levels of two neurotransmitters: serotonin and norepinephrine, involved in the stress response and release of glucose from energy stores in the body. These drugs are generally more effective than SSRIs for peripheral neuropathy.
- Tricyclic antidepressants, such as Elavil or Imipramine,don't deal with nerve pain directly, says Trence, but they make people drowsy, so they sleep better and their pain threshold is lower. "Most people have moved away from the tricyclics because of the potential side effects of dry mouth, constipation, fast heart rate," says Trence.
- Opioids such as morphine. The painkiller Ultram is often used for moderate to severe pain, while Ultracet is used for short-term relief of severe pain (up to five days). The drugs can cause dependency if used long-term. "People using these drugs unfortunately tend to get habituated," says Trence, "but occasionally a low dose, or maintenance dose, can be very helpful. It may be the only relief they get."