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If you are managing neuropathy, a good plan focuses on three goals. Reduce pain and other symptoms. Improve daily function and safety. Address the underlying cause to protect nerves and prevent complications. Your exact plan depends on the type of neuropathy and your health conditions. Many people benefit from a combination of medication, movement, mind body strategies, and consistent preventive care.
Doctors often start with medicines that have the best evidence for nerve pain relief. These include serotonin norepinephrine reuptake inhibitors such as duloxetine and sometimes venlafaxine, gabapentinoids such as pregabalin and gabapentin, and tricyclic antidepressants such as amitriptyline or nortriptyline for the right patient. For localized areas of nerve pain, topical options may help. A high concentration capsaicin patch applied in the clinic can reduce painful diabetic peripheral neuropathy and postherpetic neuralgia in some adults. A lidocaine patch can help selected people with focal neuropathic pain, though study quality varies. Your clinician will match options to your symptoms, other medicines, kidney function, and fall risk
Start low and go slow, especially if you are older or have other conditions. Drowsiness and dizziness can increase fall risk. Combining gabapentinoids with opioids or other sedatives increases the chance of dangerous breathing problems. Tricyclics can cause dry mouth, constipation, blurry vision, and blood pressure changes. Many neuropathy medicines require gradual dose changes and should not be stopped suddenly without medical guidance
Regular movement supports strength, balance, and walking confidence. For diabetic neuropathy, better glucose control paired with activity can slow progression and may lessen symptoms over time. A physical therapist can teach balance practice, safe gait strategies, and home programs that fit your abilities
Chronic nerve pain affects sleep, mood, and daily routines. Cognitive behavioral therapy and other structured pain coping programs can improve pain related distress, function, and quality of life. These skills work alongside medical care and can make medicines more effective at lower doses
Evidence for transcutaneous electrical nerve stimulation is uncertain. Acupuncture shows potential benefits for painful diabetic neuropathy in some studies, but overall quality varies and more rigorous research is needed. If you are considering supplements such as alpha lipoic acid, discuss risks and interactions with your clinician because results are mixed and products are not regulated like prescriptions
The most important step is treating the underlying condition. For diabetes, keeping A1C in your target range helps prevent or delay neuropathy in type 1 diabetes and may slow progression in type 2. Ask about vitamin B12 if you take metformin or follow a vegan diet since low B12 can cause nerve damage. Your clinician may also check thyroid, kidney, autoimmune, or toxin exposures. If symptoms suggest a pinched or compressed nerve, targeted procedures or surgery may be considered
Loss of feeling increases the risk of unnoticed injuries. Check your feet daily, wear well fitting shoes and socks, and do not go barefoot. Moisturize the skin but keep spaces between toes dry. Schedule regular foot exams with your care team and call promptly for blisters, redness, swelling, drainage, or wounds that do not heal. Early podiatry care can prevent infections and reduce the risk of ulcers and amputations
Create a steady sleep routine and discuss nighttime pain strategies. Treating depression or anxiety often improves pain coping and energy
Remove tripping hazards, add grab bars where needed, use night lights, and consider a cane or walker if balance is unsteady. An occupational therapist can suggest simple home modifications and hand or foot supports
Get urgent medical care for rapidly worsening weakness, new trouble walking, severe back pain with leg weakness, new bowel or bladder problems, fainting or dangerously low blood pressure on standing, or signs of foot infection such as spreading redness, fever, or drainage
Care can be complex. An advocate can coordinate referrals, help with prior authorizations, explain medication choices, support glucose and B12 testing follow through, and arrange physical therapy or foot care. If you are feeling overwhelmed, you do not have to do this alone. For personalized help from an Understood Care advocate, call (646) 904-4027 or book at https://app.understoodcare.com/
This content is for education only and does not replace professional medical advice. If you have new weakness, severe pain, fever with confusion, chest pain, or trouble breathing, call emergency services.
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