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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Typical pain medications sold over-the-counter such as acetaminophen (Tylenol and others) and ibuprofen (Motrin and others) are not generally effective for controlling the pain of neuropathy. These drugs may be effective for lessening pain or joint damage and deformities associated with neuropathy, but they should be used with caution because there is some concern that these drugs may worsen nerve injury.

Certain prescription medications have been shown to bring relief for those with neuropathy. In severe cases, a combination of medications may be necessary. Oral medications that have been successfully used to help the pain of neuropathy include:

• Antidepressants: Antidepressants including the tricyclic antidepressants amitriptyline (Vanatrip), imipramine (Tofranil, Tofranil-PM), and desipramine (Norpramin, Pertofrane) as well as other antidepressants such as duloxetine (Cymbalta), venlafaxine (Effexor, Effexor XR), bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa). Duloxetine has been approved by the U.S. Food and Drug Administration (FDA) specifically for treating diabetic peripheral neuropathy.
  
  
• Anticonvulsants: Anticonvulsants such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR), and lamotrigine (Lamictal). Pregabalin has been FDA-approved for the treatment of diabetic neuropathy.
  
  
• Opioids and opioid-like drugs such as controlled-release oxycodone and tramadol (Ultram)

Topical medications that may bring pain relief include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Alternative or complementary therapies like acupuncture, biofeedback, and physical therapy have been shown to be helpful in some cases.

The antioxidant alpha-lipoic acid (ALA, taken in one oral 600 mg dose daily) has been shown to be effective in treatment of diabetic neuropathy in several short-term trials; evidence for its effectiveness over the long term is not yet available.

For those whose pain is not controlled by medications, a procedure known as trans-cutaneous electrical nerve stimulation (TENS) may be an option. Although data are limited on the effectiveness of this method, a 2010 guideline issued by the American Academy of Neurology stated that TENS is probably effective for reducing pain from diabetic neuropathy.

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