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Editor's Note: We get many questions about treatments for painful neuropathy. We invited Aaron Vinik, MD, a renowned neuropathy expert, to detail various treatments for neuropathy.
The symptom for chronic, painful, diabetic neuropathy is pain persisting for more than six months. Neuropathy can normally be controlled with stabilization of blood glucose. If neuropathy cannot be controlled, however, there are two types of neuropathy pain that you might experience: C-fiber type pain and A-delta type pain. People with long-standing type 1 and type 2 diabetes are susceptible to both types of pain, but people with newly diagnosed diabetes may have an acute form of C-fiber type pain. Different therapies exist to treat each type of pain.
I. C-fiber type pain is described as burning pain that worsens at night, causing insomnia, weight loss, anxiety and depression. With C-fiber type pain, the patient often complains that the slightest touch is considered painful. For this reason, people with C-fiber type pain do not like bedclothes to be in contact with the skin, nor do they like the hairs of the skin to be disturbed. There have been a number of trials using a host of different medications in the attempt to relieve these symptoms.
II. A-Delta type pain is a more deep-seated, gnawing, toothache-type pain which often does not respond to the treatment measures used for C-fiber type pain. A-delta type pain feels like wearing a pair of shoes one size too small. Intravenous insulin infusion administered throughout the day is often helpful for patients who suffer from this type of pain. Standard diabetes treatments, including insulin and oral hypoglycemic agents, are not changed and the regular meal plan is followed. A reduction in pain usually occurs within 48 to 72 hours, and the insulin infusion can then be discontinued. If a relapse in pain occurs, the infusion can be repeated. If these measures fail, however, there are several treatments available that may abolish the pain.
Experimental Studies and Treatments
There are several reports on trials of powerful antioxidants that have been successful in Europe. The Aladdin study showed that intravenous administration of alpha-lipoic acid relieved pain. Another recently completed study on the use of nerve growth factor has shown that patients have improvements in neuropathy pain. This study, conducted throughout the world, is about to end, and the FDA has fast tracked the approval of nerve growth factor, so we can anticipate its availability for clinical use in the near future.
There are now a number of compounds being investigated for their possible use as pain-relieving drugs in diabetic neuropathy. In addition to nerve growth factor, there are also Neurotrophin 3, alpha-lipoic acid, Tramadol, Prosaptide, Timcodar, Oxycontin and ABT-594. These drugs are in phase 2 trials in the United States at a limited number of centers, and we have yet to learn of their efficacy.
I also strongly encourage exercise, and endorse the use of massage to relieve secondary muscle spasm that occurs with neuropathy pain. Exercise, by releasing endogenous endorphins, makes people feel better and makes pain more tolerable. There are institutions that use marijuana, and it does relieve some intractable pain.
Aaron Vinik, MD, PhD, FCP, FACP
Diabetes Institute, Eastern Virginia Medical School