Treatment Options for Peripheral Neuropathy

Treatment of Diabetic Neuropathy

The goal of treatment for patients with diabetic neuropathy is to alleviate symptoms and prevent progression of neuropathy. The treatment options for patients with diabetic neuropathy are similar to patients with peripheral neuropathy due to other causes. As is the case for peripheral neuropathy in general, treatment of diabetic neuropathy is primarily focused on controlling and reducing the severity of the symptoms. There are, however, some major aspects of diabetic neuropathy that require patients to be more vigilant in order to minimize the risk of major complications.

Diabetics must attempt to control their blood glucose levels to the greatest extent possible in order to prevent the progression of diabetic neuropathy. Clinical studies have shown that careful control of blood glucose levels in diabetic patients can significantly reduce both the incidence and severity of diabetic neuropathy.

Experimental treatments for diabetic neuropathy currently under investigation include:

• Aldose reductase inhibitors (e.g. tolrestat, fiderestat)
• Alpha lipoic acid
• Y-linolenic acid
• Human intravenous immunoglobulin
• Neurotrophic therapy with recombinant human nerve growth factor

Drug therapy for pain management in patients with diabetic neuropathy is similar to that for other types of peripheral neuropathy and includes:

• Antidepressants

  • tricyclic antidepressants
  • selective serotonin reuptake inhibitors
  • atypical antidepressants

• Anticonvulsants

• Antiarrhythmics
• Narcotic analgesics
• Non-narcotic analgesics
• Topical agents

As noted previously, within the past few years, two newer drugs [pregabalin (Lyrica) and duloxetine (Cymbalta)] have received approval from the U.S. Food and Drug Administration (FDA) for the treatment of neuropathic pain associated with diabetic neuropathy.

Preventing trauma and damage to the foot is also a critically important for patients with diabetic neuropathy. Patients should carefully examine their feet each night for signs of any breaks in the skin or signs of infection such as redness and swelling. Consult your doctor as soon as possible if you notice any unusual changes or if your symptoms suddenly become more pronounced. Diabetics with symptoms of small fiber neuropathy must be extremely careful with caring for their feet on a regular basis. Suggestions include:

• Daily inspection of soles of the feet and area between the toes
• Use of padded socks for all diabetics
• Wearing well-fitting and supportive shoes
• Caution with exposure to heat
• Creams for dry or cracking skin
• Powder between toes after a bath or shower
• Keeping toenails carefully trimmed

Treatment for individuals with large fiber diabetic neuropathy also includes:

• Exercise to increase muscle strength
• Gait training
• Orthotics
• Surgical reconstruction if warranted

Symptoms of diabetic autonomic neuropathy are treated individually. Examples include:

• For postural hypotension, patients should attempt to wear supportive clothing that increases blood circulation (e.g., body stocking). There are also some medications (e.g., clonidine, metoclopramide) which may be useful.
• For gastrointestinal motor symptoms, meal schedule and size may need to be modified and fat intake may need to be reduced. Some medications (e.g., metoclopramide, cisapride) may be helpful.
• For colonic problems (e.g., constipation or diarrhea) diet and medications (e.g., antibiotics) may reduce symptoms.
• For bladder problems, urinary catheterization may provide relief.
• For sexual dysfunction, glycemic control, medications, and/or penile prosthesis are helpful.
• For sweating disturbances, avoidance of certain foods (e.g., spicy foods or cheese) may reduce symptoms.