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Diabetes and Nerve Pain: Rate Your Pain
Reviewed by Brunilda Nazario, MD, August 2008.
When it comes to diabetic nerve pain, your awareness of symptoms can help find just the right treatment for you.
About 60% to 70% of people with diabetes have some form of nerve pain and damage, called diabetic neuropathy, says the American Diabetes Association. When nerve damage shows up in the feet or hands, it's called peripheral neuropathy. Some of its symptoms are obvious, like pain, tingling, or a pins-and-needles feeling in the feet. But numbness and muscle weakness are also signs of nerve damage from diabetes.
Print out this nerve pain symptom checklist, fill it out, and take it with you each time you visit your doctor or other health care professional. Be sure you take a copy to any specialists you see, such as a podiatrist (foot doctor), ophthalmologist (eye doctor), or cardiologist (heart doctor). That way, everyone on your diabetes care team will be familiar with your pattern of symptoms and can advise you on the best diet, exercise, and medications to treat your nerve pain.
1. What kind of pain or numbness do you feel?
Check off the way your pain feels, and rate your symptoms from 1 (mild) to 10 (severe).
| Has this changed since your last doctor's visit? | |
| If so, how? | |
2. Where is your nerve pain or numbness?
Check off the way your pain feels, and rate your symptoms from 1 (mild) to 10 (severe).
| Has this changed since your last doctor's visit? | |
| If so, how? | |
3. When is your pain or numbness the worst?
Check off the way your pain feels, and rate your symptoms from 1 (mild) to 10 (severe).
| Has this changed since your last doctor's visit? | |
| If so, how? | |
4. Do your symptoms keep you from any normal, daily activities?
Check off the way your pain feels, and rate your symptoms from 1 (mild) to 10 (severe).
| Has this changed since your last doctor's visit? | |
| If so, how? | |
5. What seems to relieve your symptoms?
| Activity that helps: | |
| Self-care that helps: | |
| Medications that help: | |
| Other treatment that helps: |
What causes diabetic nerve pain?
If you're wondering what causes nerve pain in the first place, it's probably a combination of factors, according to the National Diabetes Clearing House.
- Nerves exposed to high glucose levels for long periods of time
- High blood fats like high cholesterol, which damage the blood vessels that nourish nerves
- Inflammation in the nerves caused by an autoimmune response (when your body reacts to a natural internal substance as if it's foreign and tries to "fight it off")
- Genetic factors that make some people more prone to nerve damage
- Smoking and alcohol (although precisely how these cause nerve damage is still unknown).
So while you're talking with you doctor about your nerve pain, you may want to explore which of these factors may be behind your symptoms and look for solutions together. There's no final "score" that's good or bad, too high or too low. Pain is a highly personal, subjective experience. Rating your pain isn't intended to diagnose your condition but to encourage an ongoing awareness of your symptoms and an open dialogue with your doctor. And since your symptoms are likely to change over time, tracking your pain between visits with your doctor can help you feel more empowered in your health care and more in touch with your own well-being.
SOURCES: National Diabetes Information Clearinghouse: "Diabetic Neuropathies: The Nerve Damage of Diabetes," "Prevent Diabetes Problems: Keep Your Nervous System Healthy," and "Prevent Diabetes Problems: Keep Your Diabetes Under Control." American Diabetes Association: "All About Diabetes," "Diabetic Neuropathy (Nerve Damage) and Diabetes," and "Could You Have Diabetic Neuropathy and Not Know It?" WebMD Medical Reference: "Peripheral Neuropathy & Diabetes: Risk Factors & Symptoms."
Important Safety Information
Cymbalta® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.
What should I talk about with my healthcare provider?
Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.
You should also know that:
- Suicide is a known risk of depression and some other psychiatric disorders.
- Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
- All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
- Cymbalta® is not approved for use in patients under age 18.
Who should NOT take Cymbalta?
You should not take Cymbalta if:
- You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
- You have uncontrolled narrow-angle glaucoma (an eye disease)
- You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:
- about all of your medical conditions, including kidney problems, glaucoma, or diabetes
- about your alcohol use
- if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
- if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
- if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant
While taking Cymbalta, tell your healthcare provider:
- if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
- if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
- before stopping Cymbalta or changing your dose
- if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta
If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?
The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.