Pain Medicines for Diabetic Neuropathy

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Pain Medicines for Diabetic Neuropathy

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Medicines used to relieve pain caused by damage from diabetes to the nerves that supply sensation and touch (peripheral neuropathy) may include:

  • Duloxetine (Cymbalta), which is an antidepressant. It may cause dry mouth, nausea, constipation, diarrhea, and sometimes dizziness and hot flashes.
  • Anticonvulsants such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), lamotrigine (Lamictal), and topiramate (Topamax). Anticonvulsants are also frequently prescribed to reduce pain associated with diabetic neuropathy.
  • Tricyclic antidepressants such as amitriptyline (Levate), desipramine, and imipramine (Tofranil).
  • Lidocaine or mexiletine. Lidocaine comes as a patch that you can place on your skin where the pain is the worst. Mexiletine is an oral medicine similar to lidocaine. Both medicines are used to relieve pain caused by neuropathy.
  • Capsaicin cream. Capsaicin is a substance contained in cayenne peppers. Although it may not provide complete pain relief, it may help relieve minor pain in some people. Capsaicin cream is applied directly to the skin over the painful area.
  • Non-prescription pain relievers. These include acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs), such as ASA, ibuprofen (Advil, Motrin), or naproxen (Aleve). Although they may provide some temporary pain relief, they are not effective for long-term treatment of severe pain. Note: People with diabetes need to be especially careful when taking NSAIDs because these medicines may upset kidney function.
  • Narcotic pain relievers such as oxycodone, which may reduce moderate to severe pain from diabetic neuropathy. But narcotics are usually only given to people who do not have a personal or family history of addiction. Narcotics may also cause side effects that could make symptoms of autonomic neuropathy worse. So narcotics are not often the first type of medicine tried for symptoms of diabetic neuropathy.

If you begin taking a medicine for pain, it may take several weeks to evaluate whether it is working. The dose may have to be adjusted more than once to find the best balance between pain relief and medicine side effects.

No matter what you or your doctor try, you may not be pain-free. Your doctor may recommend using two or more drugs together to control your pain best. Be clear with your doctor about what is working and what is not. Together you and your doctor can find the best combination of medicine and other treatments to help you the most.

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued:

  • Advisories on antidepressant medicines and the risk of suicide. It is not recommended that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
  • A warning on anticonvulsants and the risk of suicide and suicidal thoughts. It is not recommended that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

Health Canada and the FDA also advise that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania.

Anticonvulsants may increase the chance of birth defects. If you are pregnant or thinking of getting pregnant, talk to your doctor before taking these medicines.

Related Information

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Barrie J. Hurwitz, MD, MD - Neurology
Last Revised July 14, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.