Diabetes Health Center

Treatment for Diabetes Nerve Pain

Over-the-Counter Pain Relievers for Diabetes Nerve Pain continued...

Capsaicin. Found naturally in chili peppers, capsaicin is found in drug stores under various brand names, including Capzasin-P and Zostrix. "Capsaicin has been shown to relieve pain, but there is some concern," Gibbons tells WebMD. "It may not be the best approach."

Capsaicin is thought to ease pain by reducing a chemical called substance P, which is involved in transmitting pain signals through the nerves. On a short-term basis, it is an effective approach, says Gibbons.

"But we are concerned about the long-term consequences. These same nerves play a big role in wound healing. We're concerned that capsaicin could prevent wound healing, which is already a big problem for diabetes patients."

Lidocaine. Lidocaine is an anesthetic that numbs the area it has been applied to. It is available in gels and creams, both over the counter and by prescription. Some product names include Topicaine and Xylocaine.

Other topical creams. Salicylate is a chemical similar to aspirin, and is found in pain-relieving creams like Aspercreme and Bengay. Cortisone creams contain corticosteroids, which are potent anti-inflammatory drugs that can help relieve pain. Both are available at drug stores, but there is no clear evidence that they help relieve nerve pain from peripheral neuropathy.

Prescription Drugs for Diabetes Nerve Pain

Many people need to turn to prescription medication to find relief for diabetes nerve pain. Your choices include:

NSAIDs. Although some nonsteroidal anti-inflammatory drugs are available over the counter, your doctor may suggest higher doses, or different NSAIDs, that require a prescription. There are many prescription NSAIDs to choose from including, Celebrex, Lodine, and Relafen. People with diabetes are more at risk of kidney damage that can occur with NSAIDs. In addition, people with diabetes are at high risk of heart disease, and prescription NSAIDs may raise the risk of heart problems.

Antidepressants. Although antidepressants were developed for depression, these drugs have also become important in relieving chronic pain - whether the person is depressed or not. Doctors have been prescribing antidepressants for many years for pain control, says Gibbons. Antidepressants used to treat pain include:

• Tricyclic antidepressants (TCAs) primarily affect the levels of the brain chemicals norepinephrine and serotonin. "These are the most commonly used, the best studied, and the most effective of the antidepressants used for pain," says Gibbons.

  Of the TCAs, Elavil has been a very good option for pain, yet it has troublesome side effects. "It tends to have more side effects -- drowsiness, weight gain, dry mouth, dry eyes," Gibbons says. For people with peripheral neuropathy, there can be additional side effects. Many patients develop blood pressure and heart rate problems and get dizziness when taking Elavil, he says.

  A newer drug in this class, Pamelor, is "quite effective, with fewer side effects, so it is better tolerated," says Gibbons. "Norpramin is also good and has the least side effects of all."

• Selective serotonin reuptake inhibitors (SSRIs) are a newer form of antidepressant. These drugs work by altering the amount of the brain chemical serotonin. "These are very effective for depression, but less effective for pain," says Gibbons. "They've been shown effective in some studies, but they're clearly not as effective as TCAs for pain."
  
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.

  Effexor and Cymbalta "are quite effective for pain," says Gibbons. "They are equally effective, but have fewer side effects than the SSRIs or TCAs." Cymbalta is FDA-approved for painful neuropathy; Effexor is not.