How To Treat Diabetes-Related Nerve Pain Without Surgery

Key takeaways:

Diabetic peripheral neuropathy is a type of nerve damage that can cause pain, numbness, and tingling.
Lifestyle interventions, medications, and physical therapy are first-line methods for reducing the symptoms of diabetes-related nerve pain.
When conventional treatments fail to offer relief, spinal cord stimulation is an advanced option that can significantly improve pain and quality of life for people with painful diabetic peripheral neuropathy of the lower extremities.

Diabetic peripheral neuropathy is one of the most common diabetes complications. It occurs when high blood sugar levels over time damage nerves in the extremities, such as the hands, legs, and feet. This can cause varying symptoms, ranging from mild tingling or numbness to more severe, stabbing pain.

Painful diabetic peripheral neuropathy affects up to half of people living with diabetes. For those with type 2 diabetes, the American Diabetes Association (ADA) recommends getting assessed for neuropathy starting at diagnosis, and five years after diagnosis for people with type 1 diabetes.

To avoid nerve damage and delay the development of neuropathy, the ADA suggests optimizing management strategies for blood sugar, weight, blood pressure, and lipid levels. While there are currently no existing treatments to reverse underlying nerve damage, some medications and therapies can improve symptoms and overall quality of life.

Invasive treatments like surgical nerve decompression are associated with reduced pain and restored sensation, but surgery is usually a last resort for people with diabetes, who have an increased risk of developing infections and may have difficulty with wound healing. Because of this, non-surgical treatments are often safer in the long term.

Along with managing blood sugar and improving symptoms through lifestyle changes and medication, emerging treatments like spinal cord stimulation can offer people significant pain relief.

Lifestyle changes

Effective management of diabetic peripheral neuropathy begins with aiming for in-range blood sugar, as higher glucose levels over time are linked to a greater risk of nerve damage.

Research also shows that factors related to metabolic syndrome (like higher body weight) play a significant role in the development of neuropathy, even in people without diabetes. As a result, care plans for treating diabetic peripheral neuropathy should include balanced nutrition and regular physical activity, alongside blood sugar management.

Nutrition

Anti-inflammatory diets, such as the Mediterranean diet, may be effective in reducing the severity of nerve pain and improving quality of life, all while improving insulin sensitivity and helping regulate blood sugar. Researchers have found that dietary lifestyle interventions are low-risk, low-cost, and low-tech alternatives to improve nerve pain, particularly in those with type 2 diabetes.

Certain supplements, including vitamin B (especially B1, B6, and B12) and alpha-lipoic acid, have also shown potential in reducing symptoms of diabetic peripheral neuropathy. While these supplements are generally well-tolerated, their effectiveness varies; more high-quality studies are needed to confirm their long-term benefits.

Exercise

Regular physical activity may also reduce pain and improve symptoms of neuropathy. Aiming for 30-50 minutes per day of moderate-intensity aerobic exercise (like biking, swimming, or brisk walking), strength training, or foot exercises has been shown to improve blood sugar management, increase muscle strength, enhance nerve function, and reduce inflammation. Exercise – especially resistance training like lifting weights – also helps by boosting circulation and muscle mobility, especially in the feet and legs.

Smoking

Quitting smoking is another significant lifestyle change that can slow the progression of nerve damage – and lower the risk of other serious health problems like heart disease. While research is mixed on the link between peripheral neuropathy and smoking, nicotine is known to constrict blood vessels and reduce blood flow to nerves, potentially worsening existing damage and impairing nerve repair.

Medication

Lifestyle changes can play a vital role in improving the symptoms of diabetic peripheral neuropathy, but some individuals may also require medication to help with pain management. There are a handful of FDA-approved oral medications recommended by the ADA as initial treatments for diabetes-related nerve pain:

Gabapentinoids, like pregabalin (Lyrica)
Antidepressants, such as serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine, and desvenlafaxine) and tricyclic antidepressants (amitriptyline)
Sodium channel blockers (lamotrigine, lacosamide, carbamazepine, oxcarbazepine, and valproic acid)

In addition, topical solutions such as capsaicin cream and lidocaine patches may help relieve localized nerve pain, especially for those who can’t tolerate the side effects of oral medications.

While opioids such as tapentadol are FDA-approved for severe neuropathic pain, the ADA states that opioids should not be used for nerve pain treatment in diabetes, as the risks of these medications outweigh the benefits.

Medications for lowering blood sugar or managing weight, lipid levels, and blood pressure may also be considered. If lifestyle changes aren’t enough, it’s important to talk to a healthcare provider who can recommend further treatment options for pain relief.

Physical therapy

Targeted physical therapy, particularly focused on the feet and ankles, has shown promise in improving function in people with diabetic peripheral neuropathy.

A clinical trial that tested a 12-week foot-ankle exercise program for people with diabetic peripheral neuropathy showed improvements in fast walking speed, ankle flexibility, and sensation, with some benefits lasting up to a year.

Balance training, gait correction, vibration therapy, and muscle strengthening can help reduce fall risk and improve overall mobility in people with neuropathy. Occupational therapy can also help people adapt their daily activities to reduce stress on affected areas and maintain independence. The use of orthotic devices, such as shoe inserts that redistribute pressure on the foot, can also help prevent ulcers and reduce pressure-related foot pain.

Electrical Nerve Stimulation

Additionally, complementary therapies such as acupuncture and transcutaneous electrical nerve stimulation (TENS) are sometimes used for pain relief. While TENS delivers electrical pulses through pads placed on the skin, percutaneous electrical stimulation (PENS) uses small, acupuncture-like needles that reach just under the skin to deliver these electrical pulses.

Studies suggest that both TENS and PENS may offer short-term pain relief for individuals with neuropathy, but more high-quality studies are needed to confirm their long-term effectiveness.

Spinal cord stimulation

For individuals with painful diabetic peripheral neuropathy who do not experience pain relief from lifestyle changes, medications, or physical therapies, a newer treatment option called spinal cord stimulation is a promising new approach.

With spinal cord stimulation, an implanted device delivers mild electrical impulses to the spinal cord, which can block the body’s pain signals from reaching the brain. While the device does not treat the underlying cause of neuropathy, studies have shown that spinal cord stimulation can offer significant improvements in pain relief and quality of life, as well as reduce reliance on certain medications.

Some people may still need to take pain medication, depending on their treatment goals and how advanced their condition is. While less invasive than traditional surgeries, spinal cord stimulation is still considered a surgical procedure; it’s important to discuss the benefits and risks thoroughly with your doctor to determine if this approach is appropriate for you.

The FDA has approved several neurostimulator devices for the treatment of painful diabetic peripheral neuropathy in recent years, including those from Nevro, Boston Scientific, and Abbott. Medtronic has also received FDA approval for multiple spinal cord stimulators, including their Intellis and Vanta devices in January 2022. Their most recently approved device, Inceptiv, won the silver Edison Award for Chronic Conditions Treatment Solutions from a distinguished panel of business professionals, scientists, and academia.

The Medtronic Inceptiv spinal cord stimulation system addresses a key challenge in spinal cord stimulation: dose inconsistency caused by spinal cord movement. As people go about their daily activities, change posture, breathe, or even cough, it can cause the spinal cord to naturally shift position relative to the implanted lead, which can result in inconsistent therapy dosage. Medtronic’s device uses real-time feedback to automatically adjust stimulation levels, helping to maintain consistent therapy without requiring manual adjustments.

The process usually begins with a trial phase using a temporary device to see if the therapy provides adequate pain relief. If successful, a permanent stimulator may be implanted. While there are risks associated with the procedure – some people may experience side effects such as pain, skin irritation, fluid accumulation at the implant site, or numbness or tingling in the extremities – most people tolerate the procedure well.

Insurance coverage (including Medicare) is often available, though specific benefits may vary. It’s also important to speak with your primary care provider so that they can assess your symptoms and refer you to a local pain management specialist to see if you can benefit from this treatment. Learn more about spinal cord stimulation here to see whether it may be a good fit for you.

The bottom line

Painful diabetic peripheral neuropathy is a challenging complication of diabetes, but proactive management through lifestyle changes, medications, and emerging therapies like spinal cord stimulation can greatly improve pain and offer hope for lasting relief.

Learn more about managing diabetes-related complications here:

This content was made possible with support from Medtronic. All editorial content on diaTribe is based on the editorial team’s final discretion.

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How To Treat Diabetes-Related Nerve Pain