Neuropathy Treatment

What neuropathy treatment aims to do

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.

First line treatments for neuropathic pain

Medications with the strongest evidence

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

What to know about safety and side effects

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

Non drug therapies that help

Physical therapy and exercise

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

Psychological therapies for pain coping

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

Complementary therapies

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

Treat the cause and protect your nerves

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

Foot care and injury prevention

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

Living with neuropathy

Sleep and mood

Create a steady sleep routine and discuss nighttime pain strategies. Treating depression or anxiety often improves pain coping and energy

Safety at home

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

When to call urgently

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

How an advocate can help

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/‍

FAQ

• What are the main goals of neuropathy treatment?
  Neuropathy treatment aims to reduce pain and other symptoms, improve your daily function and safety, and address the underlying cause to protect your nerves and prevent complications. Most people do best with a combination of medicines, movement, mind body strategies, and steady preventive care.
• Which medicines are usually tried first for neuropathic pain?
  First line options often 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 when appropriate. For pain in a limited area, topical treatments such as high dose capsaicin patches or lidocaine patches may help.
• How do I stay safe when starting neuropathy medicines?
  Most neuropathy medicines are started at a low dose and increased slowly. Common side effects include drowsiness, dizziness, and dry mouth, which can increase fall risk. Gabapentin and pregabalin should not be combined with opioids or other sedatives without careful supervision because of breathing risks. Many of these medicines should not be stopped suddenly, so any changes should go through your clinician.
• What non medicine treatments can help with neuropathy?
  Physical therapy and regular low impact exercise can improve balance, strength, and walking confidence. Psychological therapies such as cognitive behavioral therapy help you cope with chronic pain, protect sleep, and reduce stress. These approaches work alongside medicines and can sometimes allow you to use lower doses.
• Do complementary therapies like TENS or acupuncture work for neuropathy?
  Evidence for transcutaneous electrical nerve stimulation is uncertain, and results are mixed. Acupuncture shows possible benefit for painful diabetic neuropathy in some studies, but research quality varies. If you are thinking about acupuncture or supplements such as alpha lipoic acid, discuss them with your clinician so you understand potential benefits, risks, and interactions.
• Why is treating the underlying cause so important?
  Treating the cause is the best way to protect your nerves over time. For diabetes, keeping your A1C, blood pressure, and cholesterol in target ranges can prevent or delay neuropathy and may slow its progression. Low vitamin B12, thyroid disease, kidney problems, autoimmune conditions, and toxins or certain medicines can all damage nerves, and addressing these can prevent further injury.
• How should I care for my feet if I have neuropathy?
  Check your feet every day for blisters, cuts, redness, swelling, or drainage. Wear well fitting shoes and clean, cushioned socks and avoid going barefoot. Moisturize dry skin but keep the spaces between toes dry. Ask for regular foot exams and contact your care team quickly if you see wounds that do not heal or signs of infection.
• How can I make my home safer if I have balance or sensation problems?
  Remove loose rugs and clutter, keep pathways clear, use night lights, and consider grab bars in the bathroom. A cane, walker, or other supports may reduce fall risk if your balance is affected. An occupational therapist can suggest simple changes and equipment to make your home safer.
• When should I seek urgent medical care for neuropathy symptoms?
  Get urgent or emergency care for rapidly worsening weakness, new difficulty walking, severe back pain with leg weakness, new loss of bowel or bladder control, fainting or very low blood pressure when standing, or signs of serious foot infection such as spreading redness, fever, or drainage.
• How can an advocate support me in managing neuropathy?
  An advocate can help coordinate referrals, explain treatment options, support glucose and vitamin B12 testing follow through, assist with prior authorizations, and help you arrange physical therapy and foot care. If managing neuropathy feels overwhelming, an advocate can share the workload so you can focus on your health.

References

• American Academy of Neurology practice guideline update on painful diabetic neuropathy. Neurology 2022. PubMed record, open access summary
  https://pubmed.ncbi.nlm.nih.gov/35653393  PubMed
• Mayo Clinic. Peripheral neuropathy, diagnosis and treatment
  https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067  Mayo Clinic
• Mayo Clinic. Peripheral neuropathy, symptoms and causes
  https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061  Mayo Clinic
• National Institute of Neurological Disorders and Stroke. Peripheral neuropathy overview
  https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy  NINDS
• DCCT and EDIC findings on neuropathy outcomes
  https://pmc.ncbi.nlm.nih.gov/articles/PMC3868000  PMC
• Review of glucose control and diabetic neuropathy
  https://pmc.ncbi.nlm.nih.gov/articles/PMC5084623  PMC
• High concentration capsaicin topical system for painful diabetic peripheral neuropathy and postherpetic neuralgia
  https://diabetesjournals.org/clinical/article/43/1/165/157290/High-Concentration-Capsaicin-Topical-System-for  Diabetes Journals
• Cochrane review, topical lidocaine for neuropathic pain in adults
  https://www.cochrane.org/evidence/CD010958_topical-lidocaine-neuropathic-pain-adults  Cochrane
• FDA Drug Safety Communication, gabapentinoids and serious breathing problems
  https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin  U.S. Food and Drug Administration
• Cochrane review summary, TENS for neuropathic pain
  https://www.cochrane.org/evidence/CD011976_transcutaneous-electrical-nerve-stimulation-tens-neuropathic-pain  Cochrane
• AHRQ systematic review update, noninvasive nonpharmacologic treatments for chronic pain
  https://effectivehealthcare.ahrq.gov/sites/default/files/noninvasive-nonpharm-pain-summary.pdf  Effective Healthcare
• NIDDK. What is diabetic neuropathy
  https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/what-is-diabetic-neuropathy  NIDDK
• NIDDK. Tips to take care of your feet
  https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems  NIDDK
• CDC. Tips for healthy feet
  https://www.cdc.gov/diabetes/communication-resources/tips-for-healthy-feet.html  CDC
• NIH Office of Dietary Supplements. Vitamin B12 fact sheet for consumers
  https://ods.od.nih.gov/factsheets/VitaminB12-Consumer  Office of Dietary Supplements
• NIDDK for professionals. Prevent and treat diabetic neuropathy, include B12 checks and metformin related risk
  https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/health-care-professionals-prevent-treat-diabetic-neuropathy  NIDDK
• Mayo Clinic. Diabetic neuropathy, symptoms and causes, foot care guidance
  https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580  Mayo Clinic

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.