How Is Diabetic Nerve Pain Treated?

Medically Reviewed by Michael Dansinger, MD on February 13, 2024
4 min read

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

  • Controlling your blood sugar   and managing your diabetes can keep the pain from getting worse and improve your health.
  • Medications can help relieve nerve pain, make you more comfortable, and improve your quality of life.

If you have diabetes and peripheral neuropathy, talk to your doctor about how to manage your diabetes. 

Once you're doing all you can -- including diet, meal planning, exercise, and medication -- ask the doctor which pain treatment could best relieve the rest of your symptoms.

There are many medications that can ease nerve pain and help you function at near-normal levels. But you may need to try several different types before you find the one that works best.

Some people find relief right on drugstore shelves. Common pain relievers and some skin creams may help. It depends on how severe your pain is.

Talk to your doctor before taking any product. Even over-the-counter medications can interact with other drugs or cause severe side effects. Here are some options:

NSAIDs (nonsteroidal anti-inflammatory drugs) reduce inflammation and relieve pain. Those available without a prescription include aspirin, ibuprofen, and naproxen.

But NSAIDs are known to increase the risk of heart attack and stroke, especially when taken in high doses. They can also cause harmful side effects like stomach irritation and bleeding if you take them for a long time. They can also lead to or worsen pre-existing kidney damage, which may be more likely in people with diabetes.

Acetaminophen and other over-the-counter drugs that contain it relieve pain without reducing inflammation. These medications don't cause the stomach irritation that NSAIDs do, but taking more than recommended can lead to liver damage. Read labels and check with your pharmacist.

Capsaicin is found naturally in chili peppers. It acts on nerve cells in your skin that are involved in sending pain signals to your brain. It can help in the short term, but there are concerns about long-term use. That's because these same nerves play a role in wound healing, a process that's already a problem if you have diabetes.

Lidocaine is an anesthetic that numbs the area it's applied to. It's available in gels and creams, both over the counter and by prescription.

Many people need to turn to prescription medication to find relief.

Antidepressants treat depression but have also become important in relieving chronic pain. They can work whether you're depressed or not. Those used to treat pain include:

  • Tricyclic antidepressants, which affect the levels of the brain chemicals norepinephrine and serotonin. Experts say they're the most effective of the antidepressants used for pain. But they also cause side effects, like drowsiness, weight gain, dry mouth, and dry eyes. Blood pressure, heart rate problems, and dizziness can also happen with these drugs.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), which treat depression by boosting the brain chemicals serotonin and norepinephrine. They may have fewer side effects than the SSRIs or TCAs.

Antiseizure drugs, used to prevent epileptic seizures, can also relieve neuropathy. The drugs control the nerve cells in the brain and other parts of your body, such as legs and arms, that transmit pain. But they can make you dizzy or sleepy, especially at high doses.

Opioid medicines. When your problem is severe, you want immediate relief. That's when you should see a pain specialist. You might need strong medicines that contain a weak opioid (a morphine-like substance). These drugs also affect the brain chemicals serotonin and norepinephrine, similar to antidepressants, and reduce your feeling of pain.

Opioids can provide a better solution for "breakthrough pain" -- a kind that suddenly worsens for no apparent reason -- than OTC drugs.

Neuropathy specialists shy away from strong narcotic opioid medications. They can cause severe constipation, and there's a chance you could get addicted. There's also a stigma connected with using this type of drug. And depending on the type of work you do, it could be a problem.

Prescription capsaicin patches (Qutenza) offer the pain-relieving benefits of capsaicin in a prescription-strength skin patch. Once every 3 months, you apply up to 4 patches to your skin and leave them in place for 30 minutes.  

Injections of local anesthetics like lidocaine -- or patches that contain it -- can also numb the area.

Doctors could 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. Experts say its effectiveness is debatable.

Other useful aids to improve your quality of life include:

  • Hand or foot braces that can help muscle weakness or relieve nerve compression
  • Orthopedic shoes that can improve walking problems, which will prevent foot injuries