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Treating Painful Diabetic Peripheral Neuropathy
The toes burn and tingle and sharp pains shoot into your legs.
The bed sheets feel uncomfortable on the feet as you toss and
turn, trying to get some rest. Your feet felt numb throughout the
day, but now feel like they are on fire. Nothing seems to help as
you watch the hours on the clock pass by, hoping to fall
asleep.
Burning, numbness, tingling, hot and cold sensations, shooting
and electrical pain are common sensations felt at rest in painful
peripheral neuropathy. Neuropathy is an abnormality of the
nervous system. There are many different types of neuropathy, but
the most common neuropathy effecting diabetics is peripheral
neuropathy.
Diabetic neuropathy is described as a loss of sensation that
starts in the tips of the toes and gradually works its way up the
legs, and in severe case into the hands. It is sometimes referred
to as a stocking glove neuropathy because it progresses as if one
was pulling on a stocking.
Sixty percent of diabetics have some type of neuropathy in
their feet. Five percent of diabetics will experience painful
diabetic neuropathy and the incidence increases with age. Over
45% of individuals who have had diabetes for over 25 years will
experience some symptoms of painful diabetic neuropathy.
The cause of diabetic neuropathy is not clearly understood.
Many believe that the damage to the small vessels surrounding the
nerves, from the diabetes, causes damage to the nerves. Others
believe the increase in blood sugar causes damage to the nerves.
Despite the different theories, studies have shown better blood
sugar control helps prevent progression of the neuropathy.
There are currently no treatments to help reverse diabetic
neuropathy. There are no treatments which help reduce the
numbness. But, there are many treatments to help decrease the
pain associated with the neuropathy.
Your doctor may prescribe medications to help with the pain.
There are many options, but until recently none were FDA approved
for the treatment of painful neuropathy. Cymbalta®,
duloxetine HCl, was recently approved by the FDA in September of
2004 for use in diabetic peripheral neuropathy at doses of 60 and
120 mg per day. This is the first drug approved for this use.
Similar medications, like amitriptyline, desipramine and
nortriptyline, have been used to help decrease pain and help with
sleep.
Gabapentin, also known as Neurontin®, has been a
successful treatment for painful diabetic neuropathy.
Neurontin® was originally approved by the FDA for adjunctive
use in seizures, but the benefits of this drug for other
conditions, like neuropathy, soon became known. The manufacturers
of Neurontin® were caught up in a controversy regarding
their marketing tactics for this off label use. Many physicians
still use this drug despite the controversy. Tegretol and
Dilantin, common seizure medications, can be used in more severe
cases. New treatments include lidocaine 5% cream,
acetyl-L-canitine, nerve growth factor and Annodyne ®,
infrared therapy.
To help treat painful peripheral neuropathy without
prescription medications, consider the following tips:
1. Keep your blood sugar in control: Studies have shown that
when blood sugars remain high, or roller coaster from high to
low, peripheral neuropathy will worsen.
2. Exercise. This is probably the last thing you wanted to
hear. Exercise helps increase circulation and stimulates the
growth of new vessels which help slow the progression of the
neuropathy. Exercising also helps to increase your pain threshold
and to provide a distraction from the nerve pain in your
feet.
3. Eat healthy. Besides helping to control your blood sugar,
eating a wide variety of fruits and vegetables will add
anti-oxidants to your diet. Anti-oxidants will combat the
damaging oxidative effects glucose has on your nerves. In
particular, try dark-green, leafy vegetables, yellow, orange, and
red fruits and vegetables, citrus fruits and tomatoes.
4. Try red pepper powder. Capsaicin is the active ingredient
in chile peppers. When applied to the feet it acts as a
counter-irritant and can help decrease neuropathic pain.
Capsaicin can be purchased at your local drug store. If you
cannot afford capsaicin, try mixing 1 tablespoon of dry chile
powder with 2 tablespoons of baby powder. Place the mixture in a
sock and use the socks at night.
5. Try alpha lipoic acid. ALA is an effective anti-oxidant
that has been shown to relieve pain associated with neuropathy in
multiple studies. To help relieve pain, the dose must be at least
600mg a day. It is advisable to start with a lower dose, as
higher doses can cause nausea, stomach upset, fatigue, insomnia
and can lower blood sugar. In general, ALA is a safe
supplement.
6. Try gamma linolenic acid. GLA is an essential fatty acid
found in evening primrose oil. Most of the studies have shown
modest results, but the possibilities are still encouraging. Take
360mg/day. Many indications require higher dosages, but side
effects with long term use at higher doses may include
inflammation, thrombosis (blood clots), or decreased immune
system functioning.
Treating painful diabetic peripheral neuropathy is very
difficult and many of the above mentioned therapies should be
tried and combined. Don't expect any "cures" and make sure you
give each therapy a chance to work.
Christine Dobrowolski is a podiatrist and the author of Those
Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot
Problems. To learn more about Dr. Dobrowolski and her book visit
http://www.skipublishing.com/
or http://www.northcoastfootcare.com
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