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Neurologists Issue New Guideline for Treating Neuropathy

Feb 25, 2012

The Treatment of Diabetic Neuropathy

A team of neurologists has issued a new set of recommendations for the treatment of diabetic neuropathy, including drugs and other treatments that have been found to be the most effective therapies for the condition.

Diabetic neuropathy is damage to nerves, created by inflammation brought on by high blood sugar levels. Side effects can include severe tingling and pain as nerves are slowly destroyed by inflammation. In some cases, loss of nerve sensitivity can endanger limbs as people with diabetes unknowingly injure their legs or feet, unable to feel pain or wounds.

The guideline, published in the April 11, 2011, online issue of Neurology, was developed under the auspices of the American Academy of Neurology, in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

The neurology panel did an extensive review of the best scientific studies to create the guideline and specific drug recommendations. The guideline says that the seizure drug pregabalin is effective in treating diabetic nerve pain and can improve quality of life. However, it notes that pregabalin may not be appropriate for all patients.

The guideline also found that several other treatments show some effectiveness: the seizure drugs gabapentin and valproate; antidepressants such as venlafaxine, duloxetine, and amitriptyline; and painkillers such as opioids and capsaicin. Researchers also concluded that transcutaneous electric nerve stimulation, a portable electric device used to stimulate nerves, may be effective in treating diabetic nerve pain.

"Diabetic nerve pain is treatable, and we now have clear guidelines for this disabling condition. Many patients with diabetic neuropathy are receiving inadequate treatment or no treatment at all. This is a significant problem as the number of people with diabetes increases across the United States," says guideline author James Russell, MD, professor of neurology, anatomy, and neurobiology at the University of Maryland School of Medicine. "Diabetic neuropathy is a painful and life-altering condition, so we need to find ways to help people who are suffering with it. These new recommendations provide physicians and patients the latest information, based on sound clinical research, so they can make the best decisions about their care.

Categories: American Academy of Neurology, Amitriptyline, Antidepressants, Blood Sugar, Capsaicin, Complications & Care, Diabetes, Diabetes, Duloxetine, Foot Care, Gabapentin, Health, Health Care, Nerve Care (Neuropathy), Nerve Pain, Opioids, Painkillers, Type 1 Issues, Type 2 Issues, Valproate, Venlafaxine

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Posted by Anonymous on 24 April 2011

treating pain is one thing, but the neuronton my doctor prescribed me didn't do anyting for the numbness. I purchased a rebuilder 300 on amazon and it has worked great.. almost all of my symptoms are gone and I have hope they will all be gone one day. the nerve issue had even caused me E.D. and much to my wifes amazement--i'm back to normal!

Posted by thediabeteslady on 26 April 2011

My husband was on neurontin for over 15 years because of the nueropathy pain in both his feet. The pain level was >9. Neurontin is a very powerful medication that can affect the liver and other organs over time.
He went on a low carb diet and exercise and lost 80 pounds, came off of 43 units of insulin and best of all came off of neurontin. The neuropathy in his feet is now minimal. At worst he describes the pain level at

Posted by Anonymous on 26 April 2011

Can they please start with normalizing blood sugar (the cause) and not drugs (masking the symtpoms) such as Neurontin (aka gabapentin) which is an anti-seizure med also used as a nerve block that often causes fatigue and weight gain.

Or the anti-depressants which will likely further mess with weight, lipids, etc.

Again - please treat cause first not symptoms.
To the person who said neurontin did nothing for the numbness - it won't. It's blocks pain. As do most of these meds. Unless, I'm missing something the only thing that is really going to get sensation back is normalization of blood sugar and stimulation of the nerve endings. Please read Dr. Bernstein's book.

Doris J Dickson

Posted by Anonymous on 27 April 2011

Healthcare is focused on treating symptons and not the root causes because when it comes to the causes of an illness, there is far less return-on-investment(ROI). Its far easier to push pills then find cures. Better living thru medication. The person who mentioned weight gain as a side affect of all these drugs, I totally agree you and isn't that a real quandry for the patient that's also being told to lose the weight. Like weight loss is easy regardless. Mind as well walk up a steep hill and for every 5 steps add 20 lbs on their backs and call it a treatment.

Posted by Anonymous on 28 April 2011

I have neuropathy in my hands,feet,most of the left side of my body,it has started going up the side of my face and into my left eye recently.Mine began after chemo for breast cancer 5 years ago and has gotten worse since Diabetes diagnosis a year ago.My toes hurt so bad that I cry.Lyrica saved life.Medicare didn't want to pay for it and had me try Neurontin.I was up to 1800mg with no relief.They approved my Lyrica last week(225 mg 2x day)and after the first pill,the feeling came back in my feet.It makes me gain weight but I will gladly be fat and have the pain control it provides.

Posted by Anonymous on 22 July 2011

I purchased a device called the Rebuilder 2407 and have been using it for the last 2 months. my restless legs have been at ease since the second time i usd it and almost all of the pain and numbness are gone. I've been able to start walking around the development with my wife again and feel better than i have in a decade.

Posted by Anonymous on 26 December 2011

Please provide the info on the Rebuilder. What is it, how does it work, how to find it, cost, comparison with other rebuilder products and similar devices, etc. Thank you so much!

Posted by Anonymous on 8 January 2012

I just did an internet search on the Rebuilder 2407 and it defintely is something to look and do further resesarch on. It is expensive, but can be partially covered by Medicare.

Posted by ScottKJohnson on 26 February 2012

It's interesting to me how little we generally know about diabetes peripheral neuropathy (DPN).

As many have said, getting blood sugars as near to normal as possible is the first, and most important, thing to do. After that, it is mostly an issue of reduced blood flow. The body is unable to deliver nutrients to the affected areas, which means they are basically slowly suffocating to death.

All of the medications mentioned in this article don't treat the problem, they simply mask the pain. That is important for many, as the pain is unbearable. But it's also important for people to know that it's not doing anything to help the cause of the pain.

I'm doing some work for the company that makes Metanx, which might be an option for some to consider. It doesn't do anything to mask the pain, but rather works on improving blood flow, mending damaged myelin sheaths, and increasing nerve fiber density. It helps the body create a healthy environment to start healing the problem areas, rather than just treating the pain associated.

Posted by Anonymous on 28 February 2012

It is interesting to read the commemts here. 12 years ago my wife picked up one of those throw away pamphlets at the checkout stands. There was an article about neuropathy and how it I treated in Germany. By prescription you can get in German alpha lipitic acid tablets. No prescription is needed here in the states. At the time I was using a cane to walk my feet hurt so bad. For the first week I took 1,000mg and by the 4th day I was walking and by the end of the week no pain at all. Since that time I have taken twice a day 300mg of slow release and I’ve not had pain in years.

Posted by Anonymous on 2 March 2012

I have had Type 1 diabetes for 45 yeats. There wasn't self monitoring Blood Glucose or A1c for the first 18 years. There wasn't any carb counting either. So my BG was extremely high all the time. By 1984, I was diagnosed with Peripheral and Autonomic Neuropathy. I have had extreme pain in both legs and feet for years. I now am on dialysis, and the doctors will not allow me to take most of the Neuropathy meds. I am using Percocet every 3 to 4 hours. Doesn't help much. PLEASE, check your sugar often everyday. Follow your Doctors diet guidelines. Get an A1c every 4 months. Find out from an Endocrinologist the best insulin to use. Today, we have everything we need (education) to never get Diabetes complications.

Posted by Anonymous on 6 September 2012

I have Neuropathy in my feet and my hands go to sleep and tingle all the time.Dr.'s say hands is Carpal Tunnel and want to do surgery but I am not convinced it is CT since I have the other problem. Any thoughts on this?

Posted by Anonymous on 21 September 2013

I find as long as I keep th blood sugar under control with my insulin and diet and exercise along with the meds ie gabapentin my neorpathy pain is under control. It's all about keepi ing those numbers down. Medicine can only do so much.

Posted by Anonymous on 21 September 2013


Posted by Anonymous on 21 September 2013

I have Neuropathy in my feet. Mostly in my toes and up past the ball of my feet. I have been diagnoised as a diabetic for some 9yrs now and keep things well under control. After having 4 shoulder sergeries, with extensive nerve damage, one evening I was experiencing a bad case of burning. I looked over on the table where I had placed a tube of Voltaren Gel that my surgeon had prescribed for my shoulder. I reconized the burning as the same as I was having in my feet. I massaged some of the cream in my feet and WOW! In 5-10 minutes all my burning was gone. I am so thankful that my family doctor agreed to prescribe this for my feet.

If this could help someone else with this problem I am glad to share with you on this posting.

Posted by Anonymous on 23 September 2013

Is it possible for neuropathy to affect genitals as well ?, nothing i have taken, viagra and the rest of them has helped. And sometimes i feel a numbness in the that area.

Posted by Anonymous on 25 September 2013

It took aboput 5 Doctors, 4 Hospial visits for tests to finally diagnose what I had: NEUROPATHY. When it began it hurt so much, mostly right before I went to sleep (of course I could no sleep when the pains began), I got up and had the desire to get my feet as cold as possible...so I stood on the bathroom floor on the cold tiles. Finally one Docter diagnosed it correctly, he put me on AMITRIPTYLINE..which gave me dry mouth...which caused m to lose most of my teeth. On top the Diabetis I have 'snug' CHARCOT FOOT

Posted by Anonymous on 25 September 2013

It took several Doctors and Hospital tests to have one Doctor finally diagnose my aching feet, an ache I wish not on my worst enemy.He called it NEUROPATHY...I had never even heard of it before. Most of the time it began right before I started to go to sleep, I had to get back up to stand on the cold tiles in the bathroom. The Doctor put me on AMITRIPTYLINE, which gave me dry mouth, which caused me to lose most of my teeth...and then the Diabetes caused me to have CHARCOT FOOT on my left sole, and I have to wear special shoes prob. for the rest of my life. I am hoping I will not lose a Foot,or both. I try to live accordingly to being
diabetic, staying as 'healthy', eating as healthy as I am able to, taking
meds, having regular checkups.In addition I also have high CHOLESTEROL, Artritis in my back, I have trouble walking not only because of the CHARCOT FOOT, the Artritis presses on my spine, and that hurts when I walk too much. And I loved walking in the park with my husband and our poodle.
And they wanted to know if I had gone for a Papsmear and a Mammogram!! I have enough illnesses to last me the rest of my life, I don't need to hear of additional ones, so I just don't get tested...then I don't have anything else. Oh, and yes: I am 71 years 'young', and I am trying to stay as POSITIVE as I can.

Posted by Anonymous on 25 September 2013

hi, I am from NZ and have just found this website , thanks
I have had P/N for 14 years caused by taking the drug Amioderone to controll heart speed, all the symptons and more have plague me until times i could scream.
Ive been to 12 Spec , tried acc.punture , Tens machine,Clonidine patches ,
ect ect ect . I now am on Pregabalin, lamotrigyne, and Amitriptyline.
before retiring at night I soak my feet in cold water, knowing just when to stop,ect ect ,I am also trialing some health pills from The USA, called Neuropathy Support Formular, mainly b12 and b1 plus other additive.
Also use a St JOHNs Wart Oil, givessome relief for 2 hours , hope this may be off some help to others

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