Medication for Diabetic Neuropathy

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Medication for Diabetic Neuropathy

Question:

My father has diabetic neuropathy. He heard that there are some medications (like Cymbalta) that effectively treat or reverse the neuropathy. Is that accurate?

Answer:

That's partially accurate. Cymbalta (duloxetine) is one of many medications that may lessen symptoms of diabetic neuropathy (a common nerve disease associated with diabetes). However, there are no medications known to reverse diabetic neuropathy. The condition may be preventable with careful control of blood sugar. And, tight sugar control may prevent diabetic neuropathy from getting worse.

Besides duloxetine, other medications and treatments that may reduce the symptoms of diabetic neuropathy include:

• Capsaicin cream, isosorbide spray or lidocaine patches (topical treatments)

• Amitriptyline, paroxetine, effexor or trazodone (antidepressants)

• Gabapentin, pregabalin or carbamazepine (anti-seizure medicines)

• Alpha-lipoic acid (an antioxidant)

• Pain mediations (such as oxycodone or tramadol)

• Acupuncture

• Electrical stimulation

There is no single best treatment that reliably works for every individual with diabetic neuropathy. As a result, it may take a bit of "trial and error" to determine which of the many treatment options works best.

Symptoms of diabetic neuropathy do not always require treatment. For example, numbness or a "pins-and-needles" sensation may not be particularly bothersome or respond to medications intended to reduce pain. In addition, pain due to diabetic neuropathy may go away on its own. As a result, long-term pain treatment may not be required.

It's also worth emphasizing that neuropathy in a person with diabetes may be caused by conditions other than diabetes. For example, vitamin B12 deficiency and thyroid disease may cause neuropathy in people with diabetes. Your father should talk to his doctors about whether he has been evaluated for these other conditions and which of the many treatment options makes the most sense for him.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Last updated:	July 20, 2009