Patients’ Guide to Diabetic Neuropathy

Medications to Treat Diabetic Peripheral Neuropathy

How to Find Nerve Pain Relief

Medications are used to control the pain associated with peripheral diabetic neuropathy. Unfortunately, at this time, there aren’t any medications to treat and prevent diabetic nerve pain (another name for diabetic neuropathy); the only way to do that is through careful control of blood glucose levels.

There are many medication options to relieve pain associated with peripheral nerve damage. You should work carefully with your doctor to figure out what medications are best for you.

If you’d like to learn more about treatments for the other types of diabetic neuropathy, this section of the article reviews treatment options for autonomic, proximal, and focal neuropathy.

Medication Warning

Because of the possible interactions and side effects, always discuss medications with your doctor—even if they’re “just” over-the-counter. This is particularly important when you have diabetes because these over-the-counter medications may have interactions with other medications you’re using.

Over-the-counter Medications for Diabetic Peripheral Neuropathy

For people in the early stages of diabetic neuropathy—when the pain isn’t severe—over-the-counter medications may be enough to relieve the pain. However, people with more advanced nerve damage may not find over-the-counter medications helpful.

For diabetic neuropathy, you may want to try:

  • Acetaminophen: This is a painkiller, also known as an analgesic. Tylenol is an example of acetaminophen, and it works by blocking pain messages to the brain. In essence, acetaminophen makes it harder for the “pain” signal to travel through the nerves and to the brain, and therefore, the brain doesn’t know that it should be feeling pain.

    Possible side effects include liver damage, but that’s after taking large quantities for a long period of time.

  • Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs have a two-fold effect—they work as painkillers and they fight inflammation. They work by blocking the body from creating prostaglandins, which are chemicals that cause inflammation and pain. By taking an NSAID, you prevent your body from making as many prostaglandins, thereby decreasing inflammation and pain.

    Some common over-the-counter NSAIDs are Advil, Aleve, and Motrin.

    Possible side effects include stomach ulcers, diarrhea, nausea, and fatigue.

  • Topical Medication: There are several medications available that you apply directly to your skin; these are called topical medications.

    One option is capsaicin cream. Capsaicin is what makes chili peppers hot, and it can also relieve your pain. It just temporarily reduces your pain, though, so you'll need to keep re-applying.

    Typically, these topical medications are used by people who have foot pain (common in diabetic peripheral neuropathy).

Prescription Medications for Diabetic Peripheral Neuropathy

Most people with peripheral diabetic nerve pain need something stronger—a prescription medication—to treat the pain. You may need a combination of these to deal with the various effects of nerve damage. The FDA has approved two medications for diabetic peripheral neuropathy: Cymbalta and Lyrica. Talk to you doctor to find out if these medications may be right for your nerve pain; however, many other medications are commonly used successfully to treat diabetic neuropathy. 

Side effects include insomnia, headache, and nausea

  • Anti-depressants: It’s not required to be depressed in order to take an anti-depressant. Anti-depressants work by blocking pain messages on their way to the brain, and it’s also thought that anti-depressants stimulate the release of endorphins, which are the body’s natural painkillers.

    There are several types of anti-depressants available to treat diabetic neuropathy:

    • Tricyclic anti-depressants: By raising levels of calming neurotransmitters in your brain, tricyclic anti-depressants can, most importantly, reduce pain. They can also improve your mood and help you deal with sleep issues (it can be difficult to sleep when you have severe nerve pain).

      For diabetic nerve pain, amitriptyline (eg, Elavil, Tryptanol), desipramine (eg, Norpramin and Pertofrane), and imipramine (eg, Antideprin and Deprinol) are commonly prescribed. They’re called “first line” medications because they are among the first medications doctors will try to relieve neuropathy because they are usually effective and safe.

      Possible side effects include dizziness, drowsiness, dry mouth and eyes, and constipation.

    • Serotonin-norepinephrine reuptake inhibitors (SNRIs): Commonly called SNRIs, these anti-depressants increase how much serotonin and norepinephrine you have in your system. They do this by blocking them from being reabsorbed by brain cells; they inhibit their reuptake. With more serotonin and norepinephrine, you should have better mental balance and reduced pain.

      Doctors commonly prescribe the SNRI duloxetine (Cymbalta) to treat diabetic neuropathy. It is FDA-approved to treat the pain associated with diabetic neuropathy.

      Side effects include dizziness, drowsiness, and insomnia.

    • Selective serotonin reuptake inhibitors (SSRIs): Selective serotonin reuptake inhibitors—abbreviated to SSRI—increase how much serotonin you have. They are different from SNRIs in that they focus on serotonin. SSRIs block serotonin reuptake so that your serotonin level is increased. If you have more serotonin, you have less pain perception.

      Some examples of SSRIs are: paroxetine (Paxil) and citalopram (Celexa).
  • Anti-seizures (also called anti-convulsants or anti-epileptics): As the name implies, these medications were—and still are—used to treat seizures. They work on diabetic neuropathy by slowing down nerve signals so that the pain message isn’t transmitted as effectively.

    Some examples of anti-seizures and anti-convulsants are: pregabalin (Lyrica) and gabapentin (Gabarone and Neurontin). Lyrica is FDA-approved to treat diabetic neuropathy.

    There are possible side effects to take into consideration: drowsiness, weight gain, dizziness, and nausea.
  • Opioids (Narcotics): Opioids, also called narcotics, are very serious, heavy-duty painkillers. They can be used to provide immediate relief for severe pain, but because they can be addictive, you must exercise extreme caution and prudence when using them; use them only under a doctor’s careful supervision.

    Tramadol (Ultram or Ultracet) is an example of an opioid. Oxycodone (OxyContin) is another example that has proven useful in relieving diabetic neuropathy pain.

    Possible side effects with opioids include drowsiness, nausea, and constipation.
  • Topical Medication: In addition to capsaicin cream, which is available without a prescription, another topical medication is a lidocaine patch. You must have a prescription to use a lidocaine patch. Lidoderm is an example of a lidocaine patch.

Treatment Options for Other Types of Diabetic Neuropathy:  Proximal, Focal, and Autonomic Neuropathy Treatments

Depending on what type of diabetic neuropathy you have and the symptoms that you develop as a result, your doctor can prescribe different medications to help you handle those symptoms. For example, if you develop a urinary tract infection (a possibility if nerves to your bladder are damaged—that’s a form of autonomic neuropathy), the doctor will prescribe an antibiotic. For digestive problems—another possibility in autonomic neuropathy—the doctor may prescribe medications that make the digestive process run more smoothly. The exact medication (or medications) prescribed depends on your symptoms. Discuss all symptoms with your doctor so that he or she is best able to help you.