How can peripheral neuropathy be treated successfully?

Dr. David Erani


Nearly one-third of patients with diabetes develop neuropathy. The most common type of diabetic neuropathy is called distal symmetrical polyneuropathy (DSP). DSP typically affects the feet first and may involve the hands subsequently. The most common symptoms are paresthesias, often described as a “pins and needles” sensation, and loss of sensation. Loss of sensation is very dangerous. Without the ability to feel pain, one may not be aware of an injury and so would not tend to it. An example of this would be someone who steps on a nail which punctures the sole of their shoe, cutting their foot. They may continue to wear the shoe with the nail continuing to damage their foot until they see blood on their sock. The same person is at risk for impaired circulation from diabetes. A wound is less likely to heal when blood flow is inadequate. For these reasons, diabetes is the leading cause of non-traumatic amputations. In addition to paresthesias and loss of sensation, neuropathy can cause pain. The pain may be mild and little more than an inconvenience to the patient. In severe cases, the pain may be incapacitating. It is important to consider causes of neuropathy other than diabetes. These include vitamin B12 deficiency, which is more common among people taking metformin and is easily treated. It is also important to keep blood glucose levels well-controlled. This can slow the progression of neuropathy and may even lead to some improvement. Several different types of medications are used to treat neuropathic pain. These include tricyclic antidepressants, anticonvulsants, and narcotic pain medications. In 2011, the American Neurological Society published guidelines for the treatment of diabetic neuropathy. They found that the medication with the best evidence of benefit is pregabalin (Lyrica).

February 13, 2013 at 10:08 am

5 replies

slowgenius 2014-06-29 18:22:17 -0500 Report

I would strongly suggest that one look into the use of alpha-lipoic acid, 600mg daily. This is an over-the-counter supplement that has been well researched and has good scientific evidence to support its use for many causes. For diabetics, it has not only been found to help with peripheral neuropathy (over a period of many weeks to months-the oral form of it doesn't work overnight) but has also been found to help with glycemic control. In addition to simply Googling on it, you can find scientific peer-reviewed papers on that describe its benefits. If you've got money to spare and don't mind trying some other things as well, there may be some additional benefit to also adding some other supplements—in particular, Coenzyme Q-10 200mg and curcumin, 500mg, but I don't think the evidence for them is (yet?) as robust as it is for alpha-lipoic acid.

Goldfarb 2013-03-30 00:03:15 -0500 Report

Hey Rowl. I wondered that too when I was first diagnosed. It is not that insulin makes you gain weight, it is that with better glucose control your body is keeping all those calories it used to pee down the toilet. Along with not peeing away calories your body is also keeping more of your fluids keeping you hydrated. One of the big indicators that one has diabetes is that they loose weight. One indicator at first of better control is weight gain.

Goldfarb 2013-03-29 23:56:56 -0500 Report

I have been type 1 brittle diabetic over 30 years and recently started having pain in my feet with some loss of sensation. My neurologist put me on Lyrica which worked great. However like many patients cost and side effects bothered me. I did research and found studies where high doses of alpha lypoic acid ( found in health food stores and on- line vitamin companies) not only reduces pain, but in some cases begins to reverse nerve damage. I take 600mg two times per day. It took about a month before I was totally off Lyrica. I have only had a Lyrica once in the past 6 months and that was when I quit taking the ALPA for more than a week. Lypoic acid is considered a " universal" anti- oxidant safe for helping to rid your body of free radicals. My endocrinologist is fine with me taking this, but to be safe always check with your doctor first. Hope this helps.

lorider70 2013-03-29 19:58:45 -0500 Report

I'd give almost anything to get rid of neuropathy; but if added medication(s) are the answer; my first question would be "at what cost?"…if risky side effects would be the answer; I'm afraid "no" would be my answer. It seems a lot of newer meds put you at risk for even more undesirable side effects than the problem they are supposed to help. Why risk life threatening side effects for less pain or some immobility…