Nerve pain caused by diabetic peripheral neuropathy can be severe, constant, and difficult to treat. It may start as a tingling sensation, followed by numbness and pain. But there are two key points that everyone with diabetes and peripheral neuropathy should know:

• Controlling your blood sugar levels can help prevent worsening nerve pain and improve your overall health at the same time.
• Medications can help relieve nerve pain, make you more comfortable, and improve your quality of life.

"We know that better glucose control is the single most important factor" in preventing neuropathy, slowing its progress once you have it, and relieving many symptoms, says Christopher Gibbons, MD, director of the Neuropathy Clinic at the Joslin Diabetes Center in Boston and instructor of neurology at Harvard Medical School.

If you have diabetes and peripheral neuropathy, talk to your doctor about ways to better control your blood sugar. You may need to take insulin for better control, says Gibbons.

Once you are doing all that you can to keep blood sugar levels under control - including diet, meal planning, exercise, and medication - you should assess with your doctor which pain medication is best to relieve your remaining symptoms.

Fortunately, medications can help relieve nerve pain from peripheral neuropathy so you can function at near-normal levels. You have many pain relief drugs from which to choose. But you may need to try several different types of pain relievers before you find the one that helps you.

Over-the-Counter Pain Relievers for Peripheral Neuropathy

Some people find relief for mild nerve pain right on their drug store shelves. Common pain relievers and some topical creams may help, depending on the severity of pain.

"As a first line of treatment, these can be very helpful," Gibbons says.

Anyone with diabetes should talk to their doctor before taking any medication. Even over-the-counter medications can interact with other drugs or cause severe side effects in people with diabetes.

Here are some over-the-counter pain relief options to consider:

NSAIDs (nonsteroidal anti-inflammatory drugs). These medicines reduce inflammation and relieve pain. NSAIDs available without a prescription include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).

But NSAIDs can cause harmful side effects such as stomach irritation and bleeding in some people if taken for weeks or months. When taken long-term they can also lead to kidney and liver damage, which may be more likely in people with diabetes.

However, says Gibbons, "In many cases, especially with younger people who are relatively healthy, the risk is quite low."

Acetaminophen. Tylenol and other over-the-counter pain relievers containing acetaminophen relieve pain without reducing inflammation. These medications do not cause the stomach irritation that NSAIDs do. However, taking more acetaminophen than recommended can lead to liver damage. It is important to read labels and check with your pharmacist.

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.