Deep Dive: All of the Non-Drug Pain Treatment Options for Diabetic Neuropathy
Editor’s Note: This content was made possible with support from Nevro.
A common complication of diabetes, peripheral neuropathy affects approximately 30 percent of people with Type 1 diabetes and 42 percent of people with Type 2 diabetes. A more advanced type of peripheral neuropathy is unique to people living with diabetes and is called painful diabetic neuropathy (PDN).
Characterized by chronic pain — specifically in your legs, feet, and toes — PDN can interfere with basic daily activities and your overall quality of life. It can interfere with your work, basic tasks at home, playing with your children or grandchildren, exercising, sleep, and daily stress level.
Here, we’ll take a look at the non-drug pain treatment options for people with PDN.
First, what is painful diabetic neuropathy?
Painful diabetic neuropathy (PDN) is a condition that develops in people with diabetes who have experienced nerve damage — known as peripheral neuropathy — usually throughout the legs, feet, and toes. It is less common in the arms and hands, although possible.
It’s more common in those with chronically high blood sugar levels, obesity, high blood pressure, and poor circulation. It’s different from peripheral neuropathy alone, which impacts how nerves outside of the brain and spinal cord perceive touch and temperature and control movement and function. Peripheral neuropathy, with or without symptoms of pain, affects nearly 30 percent of people with Type 1 diabetes and 42 percent of people with Type 2 diabetes.
When basic peripheral neuropathy progresses to PDN, symptoms are different and can be intense. PDN in your legs, arms, feet, hands, toes, and/or fingers can include:
- Tingling and numbness
- Burning sensation
- Sharp, shooting, stabbing pain
- Electric-like shocks of pain
- Loss of balance and stability when walking
- Pain when walking
- Pain even with light touch
- Symptoms are often worst at the end of the day
What causes the pain? Damaged nerves are sending abnormal pain signals from your spinal cord to your brain, leading to these painful symptoms throughout your limbs.
A common issue for many people with PDN is how the daily pain interferes with getting enough sleep. Kept awake by various pain sensations, even the touch of bedsheets on your feet can be too painful.
The pain of PDN can limit your ability to do basic tasks like run errands, exercise, or play with your children or grandchildren. PDN also increases your risk of developing ulcers (wounds that won’t heal), infections, and the need for an amputation.
Non-drug treatment options for pain from peripheral neuropathy
While many people depend on pharmaceutical drugs (oral or topical) to manage chronic pain from peripheral neuropathy, many of these options can come with unpleasant side effects or become addictive.
Here are eight potential non-drug treatment options for people experiencing pain from neuropathy. We’ve listed them in order of intensity — easier changes are listed first.
Important to note — the best solution is the one that works for you. If basic solutions aren’t reducing your pain, don’t be afraid to talk to your doctor about the next option. There is never any reason to suffer through complications alone.
If you live with diabetes, particularly if you are starting to notice slight changes in your ability to feel touch or temperature in your feet, the right socks and shoes can make a big difference. Ideal socks and shoes reduce moisture from sweat or long periods of time in shoes and prevent blisters and corns.
But these products are limited in how much they can help. Instead of hoping to find significant relief from specialized footwear, consider the purchase of high-quality shoes and socks as part of your long-term foot care.
Socks: “Diabetic” socks are designed to help keep your foot dry, prevent restriction, increase blood flow. These socks are generally made with “wick away” fabrics, including cotton, spandex, bamboo, lycra, nylon, and viscose. These socks usually have zero seams — to prevent rubbing, cuts, and blisters. They tend to have more padding than standard socks — to provide additional cushioning and protection. And they’re generally white — to make it very obvious if your foot was cut and bleeding, which could lead to an infection if left untreated.
Shoes: While there are dozens of companies offering shoes and insoles for people with neuropathy, research has made some conclusions about how these shoes should be designed in order to truly support neuropathy.
Recommendations on how shoes for neuropathy should be designed include:
- Adequate interior space in length and width for your toes with a toe box high enough to accommodate conditions like hammertoes
- Zero seams in the inner lining of the shoe — to prevent rubbing or blisters
- Laces or velcro straps
- Adequate shock absorption
- Consider the durability and weight of the shoe if used during physical activity
- Provides stable support below and on all sides of the foot
- Adequate padding with any high-cut shoes
While high-quality shoes do tend to be expensive, your feet will thank you for the investment!
Early research has found that aerobic exercise and strength training may change a person’s perception of how much their neuropathy-related pain levels are impacting their life, without any actual changes in the intensity of their pain.
The study consisted of 14 sedentary people with painful neuropathy who followed a supervised aerobic (cardio) exercise program for 16 weeks. They exercised three times a week for 30 to 50 minutes using any variety of cardiovascular equipment (treadmill, elliptical, etc.) or walking outside.
The participants reported significant reductions in how much their pain interfered with daily walking, their normal work routine, their relationships, and their sleep.
While adding aerobic exercise to your routine isn’t going to reduce your pain levels, this research demonstrates that it may have other valuable benefits to your overall experience of PDN.
Potential side-effects: Exercising with PDN increases your risk of falling because of the inability to fully feel your extremities. It’s also very important to talk to your doctor before starting a new exercise routine. Exercise can potentially worsen other conditions or lead to low blood sugars if you take insulin or some other diabetes medications.
Dietary supplements: ALC and ALA
Acetyl-L-carnitine (ALC) and alpha-lipoic acid (ALA) are both non-drug supplements that have been shown to improve pain levels in people with neuropathy.
Acetyl-L-carnitine (ALC): ALC is produced by the human body and can be purchased as a dietary supplement. It’s essentially a slightly different form of L-carnitine which is an amino acid. Naturally occurring in your body, it can be found in your liver, brain, and kidneys. It has been studied for its potential effectiveness in treating a variety of health conditions, including memory loss, Alzheimer’s, neuropathy, loss of appetite, and HIV. Two different reviews (1, 2) looked at research studies using 1,000 mg of ALC daily in people with PDN. The results were fairly conclusive: ALC not only reduces pain symptoms but also improves “nerve fiber regeneration” and “vibration perception.” Potential side-effects: Nausea, vomiting, diarrhea, rash, headache, congestion, bladder irritation, bladder infections, and insomnia.
Alpha-lipoic acid (ALA): ALA is a naturally occurring antioxidant found in the body. It plays a big role in breaking down the food you eat. Research found that when taking 600 mg/dL a day intravenously (through an IV at your doctor’s office) for three weeks, it significantly reduced pain levels. Further research is required to determine if a person could then take it orally and maintain that same pain relief. Potential side-effects: When taken in safe amounts, side-effects of taking ALA are rare. Overdosing on ALA can result in skin rashes, nausea, vomiting, etc.
Electrical nerve stimulation (TENS or FREMs)
This type of electrical stimulation also includes “Frequency-modulated electromagnetic neural stimulation” (FREMs) which is a TENS technology that offers more options in terms of pulse frequency and intensity. These devices are battery-powered and deliver electrical impulses through electrodes placed on the surface of your skin near the area experiencing pain.
Research has found that TENS can provide immediate — but temporary — pain relief for people with PDN. To benefit from TENS or FREMs, the device needs to be used frequently for short sessions, and the length of pain relief varies from person to person. The FREMs technology appeared to significantly improve those struggling with cold sensations in their feet.
After 3 months of consistent treatment, the study found the benefits waned considerably.
Potential side-effects: There are no known side effects.
Patient-specific electrocutaneous nerve stimulation (“Scrambler”)
This technology is yet another electrical stimulation approach that aims to reduce the intensity of pain. The MC5-A Calmare® therapy device is FDA-approved and works with electrodes placed on your skin during treatment sessions at a doctor’s office. Sessions generally last 1 hour and are repeated daily over the course of days or weeks.
Research supporting the benefits of “scrambler therapy” acknowledges that while it has shown to be effective in treating pain from neuropathy, there isn’t a clear understanding of how it works. How often you may need treatments will vary from person to person.
There is very little research on the use of “scrambler therapy” for PDN specifically. The primary focus of research has been on the effects in people who’ve developed neuropathy after undergoing chemotherapy treatments for cancer.
Potential side-effects: There are no known side effects.
Modern acupuncture is derived from traditional Chinese medicine. It uses thin needles, inserting them just a few centimeters into your skin at specific areas based on treatment goals. Acupuncture has been studied repeatedly for its potential effectiveness in treating pain symptoms from peripheral neuropathy in people with diabetes.
In one report, ten studies were reviewed and compared. With a total of 432 participants, all 10 studies reported improvements in pain symptoms. However, acupuncture treatments within the study varied greatly, with different approaches in where the needles were placed, how long the needles were kept inserted, the total number of needles, and the frequency of treatments.
The general conclusion was that acupuncture can be an effective treatment to reduce the pain of PDN, but determining how much your pain might be reduced requires further research.
Potential side-effects: Soreness, light bleeding or bruising at needle sites, and mild pain at the time of needle insertion.
Spinal cord stimulation
Spinal cord stimulation (SCS), first used to treat pain in 1967, is well researched and used across a variety of pain management cases. Compared to medication treatments for pain, these devices are not addictive and have no side effects like drowsiness, brain fog, or upset stomach.
HFX™ for PDN, is a Senza spinal cord stimulation system that uses 10 kHz Therapy™ to treat pain from diabetic neuropathy. The HFX Solution, is the only SCS treatment option approved by the FDA to treat painful diabetic neuropathy, developed by a company called Nevro.
The Senza system is a small implantable device that is placed in your back just near your spinal cord during a minimally invasive procedure. That system is set to a specific frequency of 10kHz and sends small electrical pulses to your spinal cord. These pulses calm the nerves throughout your limbs and back. By calming those nerves, the system reduces the pain signals sent to your brain, reducing your physical pain.
According to research, about 80 percent of those who try the HFX solution experience a significant reduction in their pain levels, and 90 percent of users keep using it. This technology is a “game-changer” according to many people with diabetes who are using it to manage their PDN pain. Many users report no longer needing any other pain medications and are able to keep up with all of the physical activity they want and need to do throughout the day. For those who want to try it, there is an initial 7-day trial you will undergo to see if it’s right for you. You can start here with this basic online assessment to further determine if this technology might be a good fit for you.
Potential side-effects: After the out-patient implantation surgery, there is a low risk of infection or bleeding at the implantation site. There are no ongoing or long-term side effects.
Decompression nerve surgery
This outpatient surgery can provide significant relief from PDN pain, numbness, and tingling in your feet. It works by relieving the physical pressure on your nerves by making a small incision to access the affected nerves. Then the ligaments putting pressure on that nerve are cut. This can lead to better blood flow and enable your nerves to longer send abnormal pain signals to the brain.
The entire surgery takes approximately 1 hour. You’ll leave with stitches and dressings protecting the area for a week. You’ll also need to use crutches for a few weeks after the surgery area heals.
In research, 23 different studies were reviewed to determine the benefits of decompression surgery for neuropathy-related pain relief. All 23 studies found that most participants experienced reductions in their pain levels and improved nerve conduction. Further studies continue to support decompression surgery as a potential treatment for PDN.
Potential side-effects: Like any surgery, there are risks of infection, soreness, etc.
The bottom line
No one should have to suffer through complications from diabetes alone, and better treatments are becoming available every day. If you’re experiencing pain from diabetic neuropathy, talk to your doctor about the treatments that may be right for you.