By: Aaron Vinik
Does anyone know of an over-the-counter spray that would help neuropathy in the feet? As things go, I am using gabapentin (Neurontin) and capsaicin creams or roll-ons. I also take tramadol (Ultram) and hydrocodone for arthritis pain. None of this stuff takes the pain away completely.
Unfortunately, I know of no sprays for treating diabetic neuropathy. You are taking medications that often do help. The Neurontin and capsaicin are two of my favorites. Be sure the capsaicin (made from hot peppers) is the .075% strength and that you use it four times a day. It still takes about a month to work by depleting substance P from the nerves in your feet. The painful stimuli will then stop transmission to the brain.
Have your physicians ruled out other, nondiabetic causes for the pain? Toxic, metabolic, vascular and mechanical causes should be considered. If the problem is diabetic neuropathy, you should be sure that your glucose is tightly controlled.
Another possible medication for your doctors to consider is amitriptyline (Elavil). Nonmedication treatment can include transcutaneous electrical nerve stimulators (TENS units) and dietary supplements such as gamma-linoleic acid (evening primrose oil) and alpha-lipoic acid (thiotic acid) have also been reported to help in some cases.
Neil Scheffler, DPM
The following is taken from an online discussion conducted last September by DIABETES HEALTH board member, Dr. Aaron Vinik.
There are a lot of questions about the pain that occurs in diabetic neuropathy. The reason that many people live with their pain and do not respond to treatment is because the underlying disorder is not addressed.
When the neuropathy involves small nerve fibers, the pain is burning and stinging with feelings of pins and needles and the very slightest touch makes it worse, then the right treatment is topical capsaicin or clonidine, starting with tablets taken at night. Neurontin works for this type of pain, too, and if these fail then using amitryptylline alone or together with fluphenazine will in most instances stop the pain.
When the pain is like lightning bolts, then the right treatment is Tegretol which really should not be used under other circumstances.
When the pain is deep-seated and nauseating, like a dog gnawing at the bone or like a toothache in the foot, the first line of treatment is an insulin infusion, not to lower the blood glucose, but an insulin IV works to block this type of pain.
If the pain is in a nerve root distribution, then Tegretol again is the right drug.
If the pain is associated with degeneration of the joints and bones of the feet, then we need to toughen up the bones and the treatment is with a bisphophonate.
If the pain is on either side of the foot or if it can be localized, it may be due to a neuroma or entrapment of one of the nerves. If this is the case then diuretics, splinting and steroid injections may help. In extreme cases surgery may be necessary.
These are a few examples to illustrate the importance of making the right diagnosis if one is to achieve resolution of pain.
Aaron Vinik, MD, PhD
Director, Diabetes Research Institute
Eastern Virginia Medical School