Diabetes is the most common cause of nerve damage in the United States, and the resulting neuropathy is one of the main reasons patients are referred to a neurologist. The painful tingling sensations, which often affect both feet, can be particularly disruptive at night. Over time, the tingling and pain may spread to both legs and the hands.
I recently saw a patient with diabetic neuropathy who asked about additional ways to treat the condition beside traditional medications. I shared the following recommendations:
- Learn to manage your expectations.
No intervention is going to resolve the pain completely. Most clinical studies consider a 50 percent reduction in pain intensity (on a scale of 1 to 10) to be a good response. Instead focus on strategies to improve function at work, play, and during sleep such as the ones I’ve included here. - Find the medication regimen that works for you.
Individual responses to pain medications are variable and you may need to try a combination of drugs. Work with your doctor to choose the most effective medication with the least amount of side effects. Keep in mind that higher doses or adding more drugs also raises the chances of developing significant side effects. - Talk to a therapist.
Pain can cause feelings of anger, sadness, or anxiety, which is why it’s important to address the emotional as well as the psychological aspects of pain. Some psychologists or cognitive behavioral therapists are specifically trained to help people who experience chronic pain. A therapist can help patients identify and develop skills to modify negative thoughts and behaviors, for example, which can change their awareness of pain and improve their coping skills. - Control your diabetes.
The key to preventing neuropathy from progressing is controlling your diabetes. That means taking your medication, watching what you eat, limiting alcohol, which can aggravate neuropathy, and discussing all your medications with your doctor since certain medications can exacerbate the neuropathy. Your physician will routinely monitor your blood glucose levels with an A1c test to make sure your goals stay on target. - Take care of your feet.
Patients with diabetic neuropathy are more susceptible to foot injuries because they lack sensation in their feet. Inspect your feet on a daily basis for any sign of trauma such as red spots, cuts, swelling, or blisters—and always wear comfortable shoes. If you cannot see the bottoms of your feet, use a mirror or ask someone for help. - Consider alternative therapies.
There is enough clinical evidence to support the use of acupuncture and
relaxation techniques such as yoga and tai chi, which are good ways to stretch
and strengthen your muscles, improve your balance, and promote emotional health. - Exercise and maintain a healthy weight.
Staying active and keeping your weight down will help you control your diabetes better, which will have a positive effect on the neuropathy too. In addition, exercise induces the release of endorphins, hormones that make most people feel better. - Join a support group.
Several patient-led organizations such as the Foundation for Peripheral Neuropathy and the Neuropathy Alliance can provide assistance and a forum to share experiences with other people affected by the disease. - Participate in research.
Many institutions are actively searching for interventions that can lead to new treatments not only to control pain but also to reverse the damage caused by diabetes. Ask your doctor for available studies or visit clinicaltrials.gov, a governmental website that lists clinical studies recruiting volunteers. - Take a supplement.
If you have a specific vitamin deficiency such as B12, B1, or vitamin D, your doctor may recommend a supplement. Remember that metformin, a medication commonly used by diabetic patients, may cause a B12 deficiency. Some clinical studies suggest that alpha lipoic acid, an antioxidant available in many foods and also as a supplement, may decrease nerve pain and improve other symptoms.
For more information about nerve pain, read Smart Ways to Manage Neuropathy.
Dr. Tobon is chief of neurology at the South Texas Veteran Health Care System and associate professor of neurology at UT Health San Antonio. He loves to travel and spend time with his family.
