Diabetic neuropathy is a common complication of diabetes. It refers to nerve damage due to long periods of high blood sugar levels. In addition to controlling blood sugars, some medications are available to help manage neuropathy.

Diabetic neuropathy is a potential complication of diabetes. Over time, high blood sugar levels in the bloodstream can damage the nerves in the body. This can result in various symptoms, such as numbness, pain, tingling, and burning sensations. The condition affects different nerves depending on the type of diabetic neuropathy. Treatment, such as certain medications, may help reduce pain and improve quality of life.

In this article, we will discuss the different types of medications and treatments available for diabetic neuropathy.

Diabetic neuropathy describes nerve damage that results from diabetes. Nerves are special tissues that carry signals between the brain and other parts of the body. They enable a person to feel things, move parts of their body, and control bodily functions. However, long periods of high blood sugars and fats can damage nerves and stop them from functioning properly.

The four main types of diabetic neuropathy include:

  • Peripheral neuropathy: This is the most common type of diabetic neuropathy, affecting up to 50% of people with diabetes. Usually, this type affects nerves in the legs and feet but can also affect those in the arms and hands.
  • Autonomic neuropathy: This describes nerve damage to the nerves that control the function of internal organs. This type can lead to issues relating to the digestive system, heart rate, blood pressure, sex organs, sweat glands, bladder, and eyes.
  • Proximal neuropathy: This type is rare and refers to damage to the nerves in the thigh, buttock, or hip. After symptoms occur, they may worsen but then gradually improve after several months or years.
  • Focal neuropathy: This type typically involves damage to a single nerve. The most common forms are entrapment syndromes, such as carpal tunnel syndrome.

Approximately 25% of people with diabetic neuropathy experience pain that can interfere with their daily functioning and sleep. Without appropriate treatment, diabetic neuropathy can lead to further complications, such as ulcers and amputation.

The treatment goal for people with diabetic neuropathy includes easing pain, restoring function, and controlling blood glucose. A combination of lifestyle changes, blood sugar control, and medications may help.

As a 2022 review notes, the Food Drug and Administration (FDA) has approved different classifications of medications for diabetic neuropathy. In addition, some doctors and other regulatory boards may also recommend additional drugs, including off-label medications.

Duloxetine

Duloxetine (Cymbalta) is the only tricyclic antidepressant with FDA approval for treating the pain associated with diabetic neuropathy. It acts on the central nervous system to help block pain signals. A 2019 study notes that a daily fixed dose of 60 milligrams (mg) is beneficial for treating neuropathic pain.

Pregabalin

Pregabalin (Lyrica) is an anticonvulsant and analgesic with FDA approval for diabetic neuropathy. A 2018 review highlights that in addition to neuropathic pain, pregabalin may also help treat co-morbidities associated with diabetic neuropathy. These co-morbidities can include sleep interference and anxiety. Usually, the starting dose ranges from 75–150 mg per day in 2–3 divided doses, though a doctor may recommend different doses depending on the individual.

Tapentadol extended release

Tapentadol is an opioid with FDA approval for the treatment of diabetic neuropathy. Similar to other types of opioids, tapentadol works by changing the way the nervous system and brain respond to pain. The standard oral dose for treating pain due to diabetic neuropathy ranges from 50 to 700 mg a day. Doctors may recommend taking 600 mg per day if a person needs a continual maximum dose.

Capsaicin

Topical capsaicin has FDA approval for relieving foot pain from diabetic neuropathy. Capsaicin, which is present in chili peppers, helps reduce discomfort by blocking a pain transmitter. A 2020 study notes that this substance can help reduce neuropathic pain. A 2022 study suggests that 8% capsaicin patches are a suitable alternative for those at high risk for adverse effects from oral medication.

Other medications that do not have FDA approval but may help manage symptoms of diabetic neuropathy include:

  • gabapentin
  • amitriptyline
  • dextromethorphan
  • tramadol
  • venlafaxine
  • sodium valproate
  • 5% lidocaine patch

According to the National Institute of Diabetes and Digestive and Kidney Diseases, over-the-counter medications, such as ibuprofen and acetaminophen, do not work well for peripheral neuropathy and other types of nerve pain. Because these medications do not provide sufficient pain relief and can have side effects, some doctors may not recommend these types of medications for diabetic neuropathy.

Beyond medications, other treatment options that may help with diabetic neuropathy can include:

Managing diabetes

Managing blood sugar levels is essential for people living with diabetes. According to the Centers for Disease Control and Prevention (CDC), keeping blood sugar levels close to their target range may help slow the progression of nerve damage.

Similarly, a 2020 systematic review indicates that regular exercise and a nutritious eating pattern can help reduce symptoms of neuropathy.

Spinal cord stimulation

Spinal cord stimulation involves sending low levels of electricity directly into the spinal cord to help relieve pain. A 2021 study suggests that this method can offer substantial pain relief and improve health-related quality of life for those experiencing neuropathy. Similarly, a 2021 systematic review and meta-analysis indicates it is an effective option for those also receiving medical therapy.

Supplements and herbal medications

A 2021 review notes that currently, there is insufficient evidence to suggest that supplements, vitamins, and herbal medicines are effective for treating diabetic neuropathy. It concludes that further research is still necessary. If a person is considering taking supplements, it is advisable to first discuss them with a doctor.

Diabetic neuropathy refers to nerve damage that results from diabetes. It can lead to symptoms such as numbness, tingling, and pain. Some medications, such as anticonvulsants, antidepressants, and opioids, may help reduce these symptoms. Additionally, managing diabetes can help prevent and reduce symptoms of diabetic neuropathy.