Treating Neuropathy: Which Medication Is Best?

Diabetic Neuropathy Medication:

There are many alternative therapies that may help with pain relief on their own or in combination with medications. But check with your health care provider before using any alternative therapy or dietary supplement to make sure that you don’t have any potential interactions. In rare cases of uncontrolled diabetes, cats may experience damage to the nerves in the hind limbs, resulting in a ‘plantigrade’ stance of the hind limbs (walking or standing with their hocks on or close to the ground). Peripheral neuropathy happens when the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged.

However, these preliminary results, although interesting, will need to be confirmed in larger trials. The adverse effects of gabapentin are similar to those of pregabalin and include dizziness, somnolence, and, on occasion, gait disturbances. A recent systematic review comparing the efficacy and safety of gabapentin and duloxetine in painful DPN found image source no significant differences between the two drugs (94). Amitriptyline and other tricyclic antidepressant agents have been used for many years in the management of neuropathic pain (1,45,81,82,89). However, adverse effects are common, especially in the elderly, and include anticholinergic effects such as dry mouth, urinary retention, and drowsiness.

Moreover, phenotyping of patients with painful DPN may well lead to the development of more and better treatments for this condition. Many of the current pharmacological therapies are unsatisfactory, not only because of their adverse effects profile, but also because of their general poor efficacy and high numbers needed to treat to improve outcomes (81). Thus, more precise phenotyping of individuals with painful DPN might help to identify subgroups of patients who are more likely to respond to a given therapy. Gabapentin, similar to pregabalin, was first used as an anti-epileptic drug but has been shown to have efficacy in the management of painful DPN. However, it has a shorter half-life and therefore must be dosed three times daily.

Clinically, a formal exercise prescription can stress the therapeutic value of exercise, encourage increased activity, and regulate progression to allow tissue adaptation without causing injury. Exercise prescriptions for individuals with DPN should include information on exercise type, mode, goal intensity, frequency, and duration (Table 3). Participation in weight-bearing exercise in individuals without severe foot deformity or peripheral vascular disease has been found to be safe. Individuals with DPN should seek medical clearance for cardiovascular risk before starting a formal exercise program. As discussed earlier, DPN remains the most relevant and prevalent clinical manifestation of diabetic neuropathy and predicts the development of neuropathic foot ulcers, all-cause mortality, and cardiovascular morbidity and mortality (1,101).

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include Micromedex (updated 3 Mar 2024), Cerner Multum’ (updated 4 Mar 2024), ASHP (updated 10 Mar 2024) and others. For people with diabetes, foot and leg wounds need treatment right away.

These factors raise the risk of infections and ulcers in the feet, which in severe cases may require amputation to treat. A doctor may prescribe treatment to ease pain from diabetic neuropathy. If a person with diabetes is able to keep the condition under control, they will reduce their risk of developing diabetic neuropathy. There are many medications that can ease nerve pain and help you function at near-normal levels. But you may need to try several different types before you find the one that works best. Once you’re doing all you can — including diet, meal planning, exercise, and medication — ask the doctor which pain treatment could best relieve the rest of your symptoms.

By absorbing glucose, cells in fat deposits, the liver, and the muscles get vital fuel while lowering levels of glucose in the blood. The best way to prevent peripheral neuropathy is to manage click here for info medical conditions that put you at risk. If it affects two or more nerves in different areas, it’s called multiple mononeuropathy, and if it affects many nerves, it’s called polyneuropathy.

This distal-to-proximal axonal loss and its accompanying symptoms are the hallmark of diabetic neuropathy (23). Diabetic neuropathy is a type of nerve damage that develops gradually and is caused by long-term high blood sugar levels. While there’s no cure, managing blood sugar levels can slow its progression and prevent complications. Although getting blood glucose under control is important, it might not be enough. It is also important to control other risk factors such as high triglycerides or cholesterol, treat high blood pressure and quit smoking.

Consider discussing with your healthcare provider and checking your vitamin B levels before starting a supplement. In particular, thiamine (B1), pyridoxine (B6), folate (B9), and cobalamin (B12) are linked with neuropathy. Maintaining adequate levels of these B vitamins prevents nutritional neuropathies. Taking more than 1,500 milligrams (mg) of acetyl-L-carnitine daily reduced pain in people with diabetic neuropathy.

Other individuals who are initially aware of neuropathic symptoms may become asymptomatic later in the course of the disease, as they experience severe sensory loss in all types of nerve fibers and develop insensate feet (1,46). A serious consequence of insensate feet is an increased risk for painless injury, leading to an increased risk for foot ulceration and amputation (1,50). It is the loss of the so-called ‘gift of pain’ that causes people with plantar neuropathic ulcers to unknowingly walk on their lesions, inducing chronicity that is frequently complicated by infection (1). The treatment goal for people with diabetic neuropathy includes easing pain, restoring function, and controlling blood glucose. A combination of lifestyle changes, blood sugar control, and medications may help. Many veterinarians recommend feeding at the time of insulin injection to avoid a dangerous drop in blood glucose levels.

Schwann cells can provide energy-starved large, myelinated axons with some usable fuel, mitochondria, and protection from toxic substances (39), but small fibers lack this energy source and protection. This explains why small fibers are the earliest fibers to undergo injury secondary to diabetes and why pain and dysesthesias are frequently the first symptoms of DPN. Excess glucose also enters the hexosamine pathway, producing inflammatory by-products and activating protein kinase C (PKC) secondary to the accumulation of diacylglycerol.

A more comprehensive assessment of the impacts of social and psychological determinants of health on DPN is needed to better our understanding of potential therapeutic targets. It is likely that interventions that address more upstream causes of health disparities at structural and societal levels will be more effective for a larger population of patients at risk for DPN. Anatomical studies from sural nerve biopsies of patients with diabetic neuropathy align with their presenting symptoms (22). Early degeneration and loss of C fibers are evident in patients experiencing new-onset pain, burning, or prickling, which are known as dysesthesias, in their feet, followed by initial demyelination/remyelination of large fibers. As the disease progresses, large fiber axonal loss eventually occurs, and patients experience numbness and loss of proprioception in the feet that travels upward over time.

Neuropathy can reduce sensation and muscle control, increasing the risk of injury. Many people can still feel things, but they cannot feel pain and temperature as well,’ said Dr. Michael L. Rosenberg, a professor of neurology at Hackensack Meridian School of Medicine and JFK Medical additional reading Center in Edison, NJ. Opioids can provide a better solution for “breakthrough pain” — a kind that suddenly worsens for no apparent reason — than OTC drugs. By Heidi Moawad, MDHeidi Moawad is a neurologist and expert in the field of brain health and neurological disorders.