Severe diabetic pain is usually caused by a nerve disorder known as diabetic peripheral neuropathy. Eleven percent of patients with DPN experience intense, chronic pain that can severely impact quality of life, according to the Mayo Clinic's online medical journal, "Mayo Clinic Proceedings." Unfortunately, "little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices" for DPN pain, according to the journal. Nonetheless, there are several treatment options available for those who suffer from DPN, as well as preventive measures that patients can take to reduce their chances of DPN pain development.
Topical Treatments
Doctors recommend starting with the lidocaine patch 5 percent. This topical treatment is especially effective in the treatment of localized pain. Up to three patches can be used at one time. Apply the patch to intact skin only (avoid placing it over ulcers). After 12 hours, the patch should be removed. Capsaicin is another commonly used topical treatment.
Beginning with topical treatments is especially important for diabetics, who tend to have adverse reactions to medications. Because topical treatments are localized, they are much less likely to cause unwanted side effects.
Oral Medications
A 2005 panel of diabetes and pain management experts from the United States outlined the administration recommendations for DPN pain management. The recommendations were published in the Mayo Clinic Proceedings , and were "intended to give health professionals a definitive, consistent treatment strategy for managing the neuropathic pain associated with diabetes." The recommendations are as follows:
Experts and doctors specified duloxetine (marketed as Lilly or Cymbalta) and pregabalin (marketed as Lyrica or Pfizer) as "first-tier" drugs. Duloxetine is an anti-depressant, or more specifically, a serotonin-norepinephrine reuptake inhibitor, meaning that it increases serotonin and norepinephrine levels in the brain. Pregabalin is an anti-convulsant commonly used in the treatment of seizures. It suppresses nerve firing in the brain. Other first-tier drugs approved by the panel include oxycodone and tricyclic anti-depressants. "Second-tier" drugs include carbamazepine, gabapentin, lamotrigine, tramadol and venlafaxine.
Acupuncture
A 1998 study conducted at the University of Manchester's Department of Medicine indicates that acupuncture may be a successful alternative treatment for DPN pain. Forty-four patients received acupuncture for 10 weeks. After the treatment, 77 percent reported a significant positive change in pain, and 11 percent reported the absence of any pain at all. As noted in the study, "These data suggest that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative." A 2000 study, entitled "Percutaneous Electrical Nerve Stimulation: a Novel Analgesic Therapy for Diabetic Neuropathic Pain," produced similar results.
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