How to treat diabetic neuropathy pain?
diabetic pain relief : Neuropathy is the most common complication in diabetic patients and the second cause of morbidity and mortality, after atherosclerosis. From there derives the importance of knowing the mechanism through which this disease occurs, the measures that must be taken to prevent it and the treatments that currently exist to improve the quality of life of people who suffer from it.
The best way to prevent the onset of diabetic polyneuropathy is tight glycemic control. Multiple studies have shown that intensive control of hyperglycemia and other cardiovascular risk factors can reduce the progression of autonomic neuropathy in 6 out of 10 affected patients.
The neural damage that occurs in the vast majority of forms of diabetic neuropathy is irreversible, so the pharmacological treatment that currently exists for this condition is usually palliative, that is, it relieves the symptoms but does not cure the disease.
The most common symptom in these patients is neuropathic pain, which is often quite difficult to control. It is usually superficially perceived as a burn. In these cases, the topical application of Capsaicin in its 0.075% cream presentation is recommended up to 4 times a day. Capsaicin is an oleoresin that is part of the composition of hot peppers of the Capsicum genus.
The American Diabetes Association (ADA) recommends step therapy for painful polyneuropathy:
1. Tricyclic antidepressants. They selectively inhibit the reuptake of the neurotransmitters serotonin and norepinephrine between one neuron and another, thus relieving this type of pain. Among the most used we find:
-Amitriptyline. They are usually taken 25 to 150 mg daily in night doses (1 or 2 hours before bedtime).
-Duloxetine. The dose ranges from 60 to 120 mg daily with evaluation of the response to treatment every 3 to 4 weeks.
2. Antiepileptics. diabetic pain relief They can be given alone or in combination with tricyclic antidepressants to treat neuropathic pain.
-Gabapentin. It is recommended to start treatment with a single 300 mg dose, two 300 mg doses on the second day and three 300 mg doses on the third day. The doses can then be increased to 3600 mg per day to achieve pain relief.
-Pregabalin. The starting dose is 150 mg daily. The dose can be increased to 300 mg per day after an interval of 7 days, and if necessary, up to a maximum dose of 600 mg per day after an additional interval of 7 days.
3. Opiates. They are very powerful analgesic drugs that act on specific nerve cells and must be administered under strict medical supervision as they are potentially addictive.
In cases of muscle aches, contractures and cramps, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, ketoprofen or diclofenac, should be administered. Additionally, it never hurts to adopt traditional orthopedic measures such as wearing custom footwear, using unloading insoles and wide and flexible shoes, among others. If the pain does not subside with these drugs, there are Pain Clinics that can contribute to long-term treatment, but remember that the best treatment will always be prevention.