Improving Care for Diabetes-Related Nerve Pain

Despite diabetes-related nerve pain affecting millions of people, many find themselves cycling through ineffective treatments, including opioids (which have a higher risk for addiction), simply because better, safer options are out of reach.

A new piece of legislation, the Relief of Chronic Pain Act, aims to change that. It seeks to improve access to non-opioid treatment options for people living with chronic pain by reducing financial barriers and administrative obstacles that affect timely access, according to a letter of support to members of Congress signed by more than a dozen patient advocacy organizations, including diaTribe.

Julie H., 71, is one of many who could benefit from the reforms. Retired in Orlando, Florida, she has lived with type 1 diabetes for 42 years. Two years ago, she was diagnosed with peripheral neuropathy in her legs, feet, and hands. She said the pain has progressively worsened over the years. 

To treat the condition, as well as pain from a car accident two decades ago, she has relied on a combination of approaches, from acupuncture to opioids. 

“For 20 years, I’ve used pain management techniques like fentanyl patches and OxyContin,” she said. 

After her accident, she tried everything providers gave her for pain, including Lyrica, gabapentin, and Zanaflex.

“I’ve tried all of them,” she said. “I now take duloxetine and meclizine in desperation to improve my sleep and find some relief.”

More treatment options, better education, and lower prices for pain relief are urgently needed, she said, and called the Relief of Chronic Pain Act an important first step.

“I think the bill would allow many people who are suffering with pain to have more options available,” Julie said. “I pay a high premium for my Part D drug coverage because I know that diabetes medication and technology are expensive. Unfortunately, not everyone has that option.”

What is diabetic peripheral neuropathic pain?

Diabetic peripheral neuropathy is one of the most common diabetes complications. It happens when nerves are damaged by persistently high blood sugar levels over time. When that nerve damage produces pain – often described as burning, stabbing, electric shock-like sensations, or extreme sensitivity to touch – it's called diabetic peripheral neuropathic pain, or DPNP.

DPNP commonly affects the feet and lower legs, but can also involve the hands and arms. For many, it’s worse at night, disrupting sleep and further affecting quality of life. It can make it difficult to walk, work, and carry out everyday activities. Nearly half of people with diabetes will develop some form of peripheral neuropathy during their lifetime. For many, like Julie, neuropathy becomes painful and chronic.

Chronic pain means it lasts longer than three months, and can become linked to depression, cognitive decline, sleep disorders, and an increased risk of substance use disorders. And the economic toll is enormous – chronic pain accounts for nearly $500 billion in direct healthcare costs in the U.S. each year.

How to treat diabetes-related nerve pain

Managing DPNP begins with the foundation of all diabetes care: keeping blood sugar levels as stable as possible to slow further nerve damage. Beyond that, treatment focuses on relieving the pain itself.

Several drugs are FDA-approved for DPNP, and others are used off-label. They include:

• Anticonvulsants, such as pregabalin (Lyrica) and gabapentin, are often prescribed as first-line treatments, helping to calm overactive nerve signals.
• Antidepressants, including SNRIs (serotonin-norepinephrine reuptake inhibitors) like duloxetine, venlafaxine, and desvenlafaxine, as well as TCAs (tricyclic antidepressants) like amitriptyline, can reduce pain while also supporting mood.
• Topical agents, such as capsaicin cream or lidocaine patches, offer localized relief with fewer side effects.
• Opioids are sometimes prescribed, but evidence for their effectiveness in chronic neuropathic pain is limited, and their risks – including addiction and overdose – are significant.

While some opioids like tapentadol are FDA-approved for DPNP, the American DIabetes Association recommends that they should not be used to treat nerve pain for people with diabetes. New, more targeted non-opioid treatments are desperately needed, which is why proposed legislation like the Relief of Chronic Pain Act is so important. 

New treatments are also being studied, including pilavapadin (a non-opioid AAK1 inhibitor), which has shown promising results in early research trials for DPNP. 

Why is the Relief of Chronic Pain Act needed?

The Relief of Chronic Pain Act is federal legislation designed to improve access to non-opioid therapies for people living with chronic pain conditions, including DPNP. diaTribe is proud to be among the broad coalition of patient advocacy organizations supporting this bill.

Specifically, the bill would:

• Waive deductibles for qualifying non-opioid pain medications, so cost is no longer a barrier to starting treatment.
• Place qualifying non-opioid treatments in the lowest cost-sharing tier of insurance formularies, reducing out-of-pocket expenses for patients.
• Prohibit step therapy ("fail first") requirements for non-opioid chronic pain medications – meaning insurers could not force patients to try and “fail” with cheaper or less effective drugs before approving the treatment their doctor recommends. 

For people with DPNP, the step therapy requirement can mean months of ineffective treatment, unnecessary suffering, and an increased risk of being prescribed opioids as a result.

The support letter signed by diaTribe and other stakeholder organizations notes the lack of development of new chronic pain treatments over the past 15 years. In that same time frame, over 100 cancer drug therapies have been approved. 

“This stark contrast highlights the unique technical and economic challenges impeding the discovery, development, and marketing of novel chronic pain treatments,” the letter states.

The result is that too many people with diabetes and other chronic conditions are left to rely on off-label treatments and potentially harmful opioids to manage pain. 

“While opioids remain appropriate for some patients under careful clinical supervision, they are often ineffective for chronic pain treatment and can increase healthcare system costs through frequent patient visits, ineffective medications, and addiction-related expenses,” the letter emphasizes.

diaTribe joined this coalition to support this legislation because it would begin to dismantle barriers to access and give people with diabetes and their providers a real path to therapies that work.

The bottom line

The Relief of Chronic Pain Act won't fix every problem with treating chronic pain, but supporters say it's a meaningful step. It would seek to lower costs and barriers to treating pain, and make sure recommended treatments aren't blocked by insurers. 

People with diabetes deserve access to safe, effective, non-opioid treatment options for diabetes-related complications, including nerve pain. This bill would help begin to tear down the financial and bureaucratic barriers that keep people with chronic pain from accessing the non-opioid therapies they need.

The bill is the result of many diverse health organizations working together to focus on a common need, not only for people with diabetes, but also those living with other chronic, pain-related conditions in desperate need of better treatments, like endometriosis and fibromyalgia.

How to take action: Contact your members of Congress and let them know you support the Relief of Chronic Pain Act. To sign the petition or to learn more, click here. 

Learn more about diabetes-related complications here:

• How to Avoid Nerve Damage in Your Hands and Feet With Diabetes
• How To Keep Your Feet Healthy With Diabetes
• How To Keep Your Eyes Healthy With Diabetes

This content was made possible with support from Lexicon Pharmaceuticals. Sponsored articles are independently written by diaTribe and are subject to our standard editorial and medical review process to ensure they meet our standards for quality, accuracy, and relevancy. Final editorial authority rests with diaTribe.