For millions of people with diabetes, living with nerve pain means learning to improvise. Even the best medicines only cut nerve pain by about half, on average. And some people with diabetes might want to avoid the expense and potential side effects of additional prescription drugs.
Not surprisingly, more than half of people with diabetic neuropathy say they’ve tried complementary treatments to relieve their nerve pain.
Experts say the urge toward self-care is good. “There are a lot of effective things you can do at home to improve the pain from diabetic neuropathy,” says Sue McLaughlin, RD, CDE, president of health care and education for the American Diabetes Association. “You live with it every day, and you can do something positive about it daily, too.”
Peripheral Neuropathy: The Not-So-Minor Complication of Diabetes
Diabetic nerve pain is caused by nerve damage, the result of the toxic effects of high blood sugars and poor circulation. Over time, as more nerve fibers are lost, nerves lose their ability to transmit sensation. Numbness in the feet and legs is the common symptom that two-thirds of people with diabetes experience at some point.
The damage also makes nerves more likely to misfire. They may send pain signals in response to ordinary touching or for no apparent reason. “People frequently describe nerve pain as burning, electrical shocks, or pins and needles,” says McLaughlin. Nerve pain is usually in the feet and legs, but can also be in the hands.
About 25% of people with diabetes experience nerve pain. Pain can range from annoying to debilitating, even making simple daily activities intolerably painful. Because symptoms are usually worse at night, neuropathic pain often interferes with sleep, and mood problems such as irritability and depression can follow.
“Diabetic peripheral neuropathy is a so-called minor complication of diabetes, but not to the people who live with the pain it creates,” says Laurence Kinsella, MD, professor of neurology at Saint Louis University and a fellow with the American Academy of Neurology.
“Medicines, and doctors for that matter, can only do so much. Everyone with this condition should be doing certain things for themselves at home too,” Kinsella says.
WebMD asked the diabetes experts for guidance on some of the most widely used home care therapies for diabetic nerve pain. Here are the top 10 strategies — some old standbys and a few surprises.
The Top Neuropathic Pain Treatment: Controlling Blood Sugar Levels
When it comes to reducing pain from diabetic neuropathy, “controlling your sugar isn’t just your No. 1 strategy; it’s practically the whole top ten,” says McLaughlin.
The toxic effects of high blood sugar are what cause nerve damage and nerve pain in the first place. Continued high sugar “only lets the process continue,” says McLaughlin. But keeping sugars close to normal can stop ongoing damage and improve the pain of diabetic neuropathy, studies show. And because some diabetic nerve damage might be reversible, reducing sugar may have even more benefits.
Preventing Neuropathic Pain With Foot Care
Nerve pain is often what brings people with diabetic peripheral neuropathy to see a doctor. But it’s numbness in the feet that lands them in the hospital, Kinsella tells WebMD. “It’s the little rock you stepped on five days ago without feeling it,” Kinsella says, that can lead to “poorly healing ulcers, infections, and even amputations.”
Some ways to care for your feet:
- Clean and inspect them every day. “Any sore or ulcer that isn’t healing normally is worth showing to a podiatrist or your primary doctor,” Kinsella says.
- Wear comfortable shoes. Kinsella suggests asking for help at a store that specializes in shoes for neuropathic feet.
- Wear socks with padding at the ball of the foot and the heel.
- Cut your toenails straight across or allow a podiatrist to cut them for you. When it comes to avoiding complications, says Kinsella, a podiatrist trim “costs about ten bucks, and it’s money well spent.”
Walking to Heal Damaged Nerves
Because exercise improves blood flow to leg and foot nerves, a regular exercise program may nourish damaged nerves back to health. A landmark study found that a program of regular walking prevented neuropathy in most people with diabetes during the course of the study. Walking also slowed the progression of neuropathy in those who had already developed the condition.
“Exercise helps reduce blood sugars overall,” McLaughlin points out, making diabetes easier to control. Also, exercise increases people’s tolerance levels for nerve pain, she says.
Warm Water Treatment for Diabetic Neuropathy
Some people find that a regular warm bath provides some relief from mild nerve pain. Warm baths boost blood flow to the skin of the legs and feet. And because they’re relaxing and stress- reducing, they can help make pain easier to tolerate.
“Warm baths are a good, safe option,” says Kinsella, as long as you’re careful about the heat. “Check the water temperature with your arm, not your feet, before stepping in.”
Vitamin B Complex May Help Nerve Pain
The B vitamins (B-1, B-12, B-6, and folic acid) are essential for nerve health. Most people get enough B vitamins just from eating a healthy diet, but controlled studies differ on whether taking a B vitamin supplement improves nerve pain.
Kinsella recommends taking daily B vitamins because they are “a generally inexpensive, safe measure that will help some people.” He advises 25 milligrams of thiamine (B-1), 500 micrograms of B-12, 25 milligrams of B-6, and at least 1 milligram of folic acid.
He cautions against higher doses of B-6. “Don’t go higher than 50 milligrams a day.” Kinsella says. Taking the supplement in high doses and long term can lead to toxicity, and cause pain and numbness in the hands and legs, and in severe cases even difficulty walking.
Over-the-Counter Pain Relievers
Acetaminophen, aspirin, ibuprofen (Motrin), and naproxen (Aleve) are better for headaches than nerve pain, most experts say. Still, they can play a part in your home treatment plan for neuropathic pain.
McLaughlin advises talking to your doctor before using them to improve pain. “Some of these medicines can be hard on your kidneys,” she says, so never go above your doctor’s recommended dosages.
Capsaicin: The Hot Chili Pepper Treatment
Who knew that chili peppers could reduce nerve pain? Made from hot peppers, capsaicin cream rubbed on skin affected by nerve pain can bring relief. In one important study, more than two-thirds of people using capsaicin reported improvement in nerve pain.
Capsaicin does help, but you have to be religious about using it, Kinsella tells WebMD. “You have to apply it three or four times a day and know that for a few weeks, it will feel worse before it gets better.”
Less Beer for Less Pain
A drink of alcohol a day can provide health benefits to some people, but it may be too much for those with diabetic neuropathy. “High levels of alcohol are toxic to nerves, especially nerves that are already injured,” Kinsella says. Reduce the amount of alcohol you drink. Kinsella advises no more than four drinks per week.
Evening Primrose Oil and Diabetic Neuropathy
Extracted from the evening primrose plant, this oil is rich in omega-6 fatty acids, which are important structural components of cell walls. Theoretically, supplementing the diet with evening primrose oil, which is available in pills, may boost the repair or regrowth of damaged nerves cells.
In two clinical trials, taking evening primrose oil orally improved nerve function somewhat in people with diabetic neuropathy. The risks of evening primrose oil are small, but they include possible increased bleeding in people who take daily aspirin or prescription blood thinners.
It can be necessary to take up to 12 capsules of primrose oil a day to see effects, which some people may find inconvenient. “I know this is out there as a suggested treatment,” McLaughlin tells WebMD, “but I don’t think there are sufficient studies to support its use.”
Botanical Oils for Nerve Pain
Some studies have shown that applying botanical oils such as geranium oil can reduce the pain of postherpetic neuralgia. Other oils, such as lavender oil, have been shown to help relax people, which may also help take the mind off nerve pain.
Alpha-Lipoic Acid May Help Diabetic Peripheral Neuropathy
This potent antioxidant, also called thioctic acid, clears so-called free radicals from the body, potentially reducing nerve damage. In Germany it is used to treat nerve pain and damage from diabetes.
Alpha-lipoic acid given orally or intravenously (600-1,200 milligrams per day) seems to be effective at reducing nerve pain in people with diabetes. For some people, it may help reduce the symptoms of burning, numbness, and prickling in the feet.
“Studies are mixed as to whether alpha-lipoic actually reverses any nerve damage,” McLaughlin says.
No major diabetes treatment group has yet endorsed alpha-lipoic acid.
The Most Effective Treatment for Nerve Pain: Keep at It
Unfortunately, there is not enough scientific evidence to provide solid guidance on some of the alternative treatments for diabetic neuropathy pain. But don’t let that make you avoid self-care altogether.
“Most people with painful diabetic neuropathy need a combination of both medicines and self-care strategies,” says Kinsella. Try low-risk, low-cost options for home care first. And if you’re considering supplements, remember that all supplements can have side effects, so tell your doctor about any new treatment you want to try.