Beating Neuropathy Pain

Introduction

Neuropathy pain is real and it can get in the way of walking, sleep, and daily life. Although neuropathy is often long lasting, you can reduce pain and improve function with a combination of treatments and practical supports. If you are managing diabetic peripheral neuropathy, post shingles nerve pain, or nerve pain after an injury or back problem, the same stepwise approach can help you feel and move better.

To make this guide easy to use, we combine the best available medical evidence with the real world strategies highlighted in the video script. We also link to related Understood Care resources that can help you put the plan into action, including mobility equipment support at https://understoodcare.com/care-types/mobility-equipment

What neuropathy is and why it hurts

Neuropathy means the nerves outside your brain and spinal cord are damaged. That damage can come from diabetes, injuries, compression from spine conditions, toxins, infections, autoimmune disease, or sometimes no clear cause. Damaged nerves can misfire and send pain signals even without an outside trigger.

Common causes

• Diabetes and blood sugar related nerve injury
• Nerve compression or trauma including back and spine problems
• Toxins such as alcohol and certain drugs
• Autoimmune and metabolic disorders
• Infections such as shingles that can lead to postherpetic neuralgia
• Vitamin deficiencies such as B12
  These causes and mechanisms are well described by national neurology and medical centers.

Symptoms you might feel

People describe neuropathy pain in many ways. You might notice burning, pins and needles, tingling, electric shock sensations, shooting pains, or numbness with loss of protective feeling. Balance can feel unsteady and feet can seem weak or heavy. The symptoms often start in the toes and feet and can move upward. Medicines used for nerve pain can sometimes cause sleepiness, dizziness, swelling of the legs or feet, and confusion, so it is important to know what to watch for.

First line treatments that reduce neuropathy pain

Medicines that calm overactive nerve signals

Several medicine classes can lower neuropathic pain. Your clinician usually starts with one medicine, increases slowly, and switches or adds another option if relief is not enough or side effects limit use.

Gabapentin and pregabalin
These medicines reduce abnormal nerve firing. They can meaningfully reduce pain for some people, though not everyone benefits. Evidence shows that higher doses taken as tolerated are often needed, and side effects such as dizziness and sleepiness are common.

Duloxetine and other antidepressants used for nerve pain
Duloxetine, a serotonin norepinephrine reuptake inhibitor, has consistent evidence for painful diabetic peripheral neuropathy and can lower pain intensity while improving function. Tricyclic antidepressants such as amitriptyline are also used, though the strength of evidence varies and side effects can limit use in some older adults.

What guidelines say
The American Academy of Neurology guideline update supports the use of several oral and topical therapies for painful diabetic polyneuropathy and discourages routine use of opioids for chronic neuropathic pain. Your care plan should consider benefits, risks, and personal goals.

Topical therapies for localized areas

Lidocaine 5 percent patches can help some people with localized neuropathic pain by numbing overactive skin nerve endings. Evidence is mixed across conditions, but use is common in practice because side effects are usually mild and the medicine acts where it is applied.

Capsaicin 8 percent patch is an in clinic option for neuropathic pain conditions, including a United States Food and Drug Administration indication for diabetic peripheral neuropathy of the feet and for postherpetic neuralgia. It can provide weeks of relief after a single application and can be repeated at intervals.

What to expect and how to stay safe

Start low and go slow with new medicines. Expect a gradual dose build over several days to weeks, especially with gabapentin, pregabalin, and duloxetine. Report swelling, worsening balance, mood changes, or confusion right away.  Clinical overviews align with guidance from major centers.

Therapies beyond medication

Physical and occupational therapy

Strength, balance, and gait training reduce fall risk and improve day to day function in diabetic peripheral neuropathy and other neuropathic conditions. Even small, regular gains in ankle and hip strength can translate into steadier walking. Randomized trials and meta analyses support exercise programs focused on lower body strength and balance.

If your feet feel unsteady, ask about a therapy referral and a home safety check. Understood Care can help you get fitted for the right walker or rollator at https://understoodcare.com/care-types/mobility-equipment‍

Footwear and protective devices

Supportive, well fitted shoes and offloading devices reduce pressure on sensitive areas and help prevent ulcers that can worsen pain and lead to infection. Diabetes guidelines emphasize routine foot checks, protective footwear, and prompt care for any sores or calluses.

TENS and other modalities

Transcutaneous electrical nerve stimulation is a non drug option that some people find helpful. Evidence for neuropathic pain is mixed. A Cochrane review found it difficult to confirm a clear benefit across studies, while a large 2022 review reported lower pain during or immediately after TENS with generally mild side effects. If you try TENS, ask your clinician or therapist to help you set intensity and placement for safety.

Pain coping skills

Cognitive behavioral therapy and related skills training can reduce pain interference, improve sleep, and support daily function when added to medical care. Studies in diabetic neuropathy and other chronic pain conditions show benefits in quality of life and coping.

Treat the cause and protect your nerves

If diabetes is part of your story, blood glucose control and cardiovascular risk management are essential for slowing progression and preventing complications. The American Diabetes Association Standards of Care outline screening for neuropathy and foot care steps each year, with more frequent checks if problems are found.

Other causes matter too. Your clinician may check B12 and other vitamins, thyroid levels, alcohol use, medications that can injure nerves, infections, and autoimmune markers. Treating what is treatable protects the function you have.

Daily strategies you can use

Move most days

• Short, regular sessions of walking or seated exercise can help with circulation and balance
• Add gentle strength and balance drills from your therapist’s plan
  Evidence supports exercise to improve balance and reduce fall risk in diabetic peripheral neuropathy.

Protect your feet

• Inspect daily for blisters, redness, cracks, or sores
• Wear cushioned, well fitted shoes and moisture wicking socks
• Call your clinician quickly for any wound, drainage, warmth, or swelling
  Diabetes foot care education stresses protective footwear and prompt care for ulcers.

Sleep and stress

• Keep a consistent sleep schedule and use relaxation techniques
• Ask about a referral for pain coping skills if pain disrupts life
  These skills complement medical care and support better function.

When to seek urgent care

Call your clinician or urgent care if you have any of the following

• New or rapidly worsening weakness or sudden loss of balance
• A foot wound with spreading redness, fever, warmth, or drainage
• Severe uncontrolled pain or new trouble with bladder or bowel control
• Confusion, severe drowsiness, or swelling after starting a new medicine

These red flags require prompt evaluation. They are aligned with major medical center guidance on neuropathy and medicine safety.

How an advocate helps you beat neuropathy pain

The video highlights a practical reality. Neuropathy care works best when someone helps coordinate the moving parts. An advocate can

• Help your clinician select and adjust medicines and watch for side effects
• Prepare prior authorizations and look for patient assistance programs when cost blocks access
• Arrange physical and occupational therapy and share the clinic wording needed to prioritize balance and gait goals
• Fit and order the right walker or rollator and plan for delivery and training
• Book transportation so you can safely get to visits and therapy
• Keep the plan organized, from records and referrals to follow up

What the video covers in plain language

• Neuropathy has many causes including diabetes, injuries, trauma, and back problems, and it commonly affects balance
• People describe pain as numbness, tingling, pins and needles, burning, or shooting
• Gabapentin is common but not the only option, and doses often increase over time for effect
• If a medicine is not covered, an advocate can help with prior authorization or manufacturer assistance
• Therapy and the right shoes or mobility devices support stability and may relieve some pain
  These points align with major neurology and diabetes sources and modern guidelines for painful diabetic neuropathy.

FAQ

• What is neuropathy and why does it hurt so much?
  Neuropathy happens when the nerves outside your brain and spinal cord are damaged. This damage can come from diabetes, injuries, back or spine problems, infections like shingles, vitamin deficiencies, toxins such as alcohol, or autoimmune diseases. Damaged nerves can misfire and send pain signals even when nothing is touching them, which is why the pain can feel constant or out of proportion to what you are doing.
• What does neuropathy pain feel like?
  People describe neuropathy in many ways. It might feel like burning, pins and needles, tingling, electric shocks, stabbing or shooting pain, or numbness with loss of feeling. Feet can feel weak, heavy, or unsteady. Symptoms often start in the toes and feet and can move upward. On top of that, some nerve pain medicines can cause sleepiness, dizziness, leg swelling, or confusion, so it helps to know what to watch for.
• What are the most common causes of neuropathy?
  Common causes include diabetes and high blood sugar, back and spine problems that compress nerves, past injuries, alcohol and certain drugs, vitamin B12 deficiency, infections like shingles, and some autoimmune or metabolic conditions. In some people, a clear cause is never found, but treatment can still focus on reducing pain and protecting function.
• What medicines are usually tried first for neuropathy pain?
  Clinicians often start with medicines that calm overactive nerve signals. These include gabapentin or pregabalin, which reduce abnormal nerve firing, and antidepressants that also work on pain, such as duloxetine or sometimes amitriptyline. Your clinician usually starts with a low dose, increases slowly, and changes the plan if relief is not enough or side effects are too strong.
• Are opioids recommended for chronic neuropathy pain?
  Major neurology guidelines do not recommend routine use of opioids for long term neuropathic pain. They focus instead on nerve pain medicines, certain antidepressants, topical treatments, exercise, and coping skills. Opioids may have a role in specific short term situations, but they carry significant risks and are not a first line treatment for chronic neuropathy.
• What topical treatments might help?
  Topical lidocaine 5 percent patches can reduce pain in a focused area by numbing the surface nerves. They tend to have mild side effects. Capsaicin 8 percent patches are an in clinic option for painful diabetic neuropathy of the feet and for post shingles nerve pain. One application can provide relief for weeks and can be repeated on a schedule set by your clinician.
• What should I expect when starting neuropathy medicines?
  Most neuropathy medicines are started at a low dose and increased slowly over days to weeks. This gives your body time to adjust and reduces side effects. You should call your care team right away if you notice new swelling in the legs or feet, worse balance, mood changes, confusion, or severe sleepiness. It often takes time and careful adjustments to find the right dose and combination.
• Besides medicine, what else can help with neuropathy?
  Physical and occupational therapy can improve strength, balance, and gait so you feel steadier on your feet and reduce your fall risk. Supportive shoes and pressure relieving inserts or devices can protect sensitive areas and prevent ulcers. Some people find transcutaneous electrical nerve stimulation (TENS) helpful, although research results are mixed. Pain coping skills such as cognitive behavioral therapy can reduce how much pain interferes with sleep and daily life.
• How can I protect my feet if I have neuropathy?
  Check your feet every day for redness, blisters, cracks, or sores. Wear cushioned, well fitted shoes and moisture wicking socks. Never ignore a new wound, warmth, or swelling. Call your clinician quickly if you see a sore that is not healing or any drainage. Foot care and protective footwear are essential parts of preventing infections and serious complications, especially in people with diabetes.
• Does treating the cause of neuropathy still matter if the pain has been there for years?
  Yes. If diabetes is involved, keeping blood sugar in a safer range and managing heart and blood vessel risk can slow further nerve damage. Your clinician may also check vitamin levels, thyroid function, alcohol use, medicines that can injure nerves, infections, and autoimmune markers. Treating what is treatable helps protect the nerve function you still have, even if symptoms have been present for a long time.
• What daily strategies can I use at home?
  Short, regular sessions of walking or seated exercise can help circulation and balance. Gentle strength and balance work, guided by a therapist, can make walking steadier over time. For sleep and stress, a regular bedtime, relaxation techniques, and pain coping skills can reduce how much pain dominates your day. Small, repeatable routines usually work better than big changes that are hard to keep up.
• When is neuropathy a reason to seek urgent care?
  You should seek urgent or same day care if you notice new or rapidly worsening weakness, sudden major balance problems, a foot wound with spreading redness, warmth, fever, or drainage, severe uncontrolled pain, new trouble with bladder or bowel control, or confusion or severe drowsiness after starting a new medicine. These can be signs of serious complications that need prompt evaluation.
• How can an advocate help with neuropathy care?
  An advocate can help your clinician choose and adjust medicines, watch for side effects, and prepare prior authorizations when cost blocks access. They can arrange physical and occupational therapy, help you get fitted for a walker or rollator, and plan delivery and training. Advocates also help with transportation to appointments, organize records and referrals, and keep your overall plan on track so you do not have to manage everything alone.

References

• National Institute of Neurological Disorders and Stroke. Peripheral Neuropathy. https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy
• Mayo Clinic. Peripheral neuropathy overview and diagnosis. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 and https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067
• American Diabetes Association. Retinopathy, Neuropathy, and Foot Care Standards of Care in Diabetes 2025. https://diabetesjournals.org/care/article/48/Supplement_1/S252/157552/12-Retinopathy-Neuropathy-and-Foot-Care-Standards
• American Academy of Neurology. Oral and Topical Treatment of Painful Diabetic Polyneuropathy Practice Guideline Update 2022. https://www.neurology.org/doi/10.1212/WNL.0000000000013038
• Cochrane Library. Gabapentin for chronic neuropathic pain in adults. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007938.pub4/full
• Cochrane Library. Duloxetine for treating painful neuropathy and chronic pain. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007115.pub3/full
• Cochrane Library. Pregabalin for neuropathic pain in adults. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007076.pub3/full
• U S Food and Drug Administration. Qutenza capsaicin 8 percent topical system label including diabetic peripheral neuropathy of the feet indication. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/022395s019lbl.pdf
• National Institutes of Health PubMed Central. Topical lidocaine for neuropathic pain in adults. https://pmc.ncbi.nlm.nih.gov/articles/PMC6540846
• Cochrane Library. Transcutaneous electrical nerve stimulation for neuropathic pain. https://www.cochrane.org/evidence/CD011976_transcutaneous-electrical-nerve-stimulation-tens-neuropathic-pain
• BMJ Open. Efficacy and safety of transcutaneous electrical nerve stimulation in acute and chronic pain systematic review and meta analysis 2022. https://pubmed.ncbi.nlm.nih.gov/35144946
• Cleveland Clinic Health Library. Diabetic neuropathy treatment and rehabilitation overview. https://my.clevelandclinic.org/health/diseases/21621-diabetic-neuropathy
• Randomized and systematic evidence for strength and balance training in neuropathy. https://pmc.ncbi.nlm.nih.gov/articles/PMC5385995 and https://pmc.ncbi.nlm.nih.gov/articles/PMC10065320
• American Diabetes Association. Diabetes and your feet and foot complications. https://diabetes.org/health-wellness/diabetes-and-your-feet/foot-care-tips and https://diabetes.org/about-diabetes/complications/foot-complications

This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.