Neuropathy: Going Beyond Tablets for Treatment
Neuropathy is a notoriously tough complication of type 2 diabetes. Nighttime leg pain, numbness, burning, shooting pains, extreme sensitivity to touch, and even changes to the shape and function of your foot can all be part of living with neuropathy.1
Many people with diabetes describe the pain, loss of function, and interruptions to sleep as the hardest parts of living with neuropathy day to day. There are prescription medications like duloxetine (Cymbalta®), pregabalin (gabapentin), and amitriptyline, among others, that may help.1
However, sometimes these tablets aren't enough, or people have difficulty with side effects at higher doses. That means exploring additional options is important. Two to consider discussing with your provider are Qutenza® (capsaicin 8 percent) and a spinal cord stimulator (these are made by multiple different companies).
What is Qutenza?
Qutenza is a topical treatment, not a pill or injection. Topical treatments are medicines that are placed on your skin. Qutenza is not used at home, so you’ll have to get your treatment at your provider's office.2
Large, clear patches with Qutenza will be wrapped around your feet and left in place for 30 minutes. After 30 minutes, the patches will be removed and your feet cleaned. This process is repeated every 3 months.2
Benefits and side effects of Qutenza
Qutenza targets the TRPV1-expressing pain fibers and the thickness of those nerve fibers. This interrupts the pain signals from those nerves to your brain. The effect lasts for about 3 months.3
In a 1-year study, 3 out of 4 people had more than a 30 percent reduction in their neuropathy pain when Qutenza was added to their care plan. Some folks had a greater than 50 percent reduction in their pain! Over half of the study participants reported an increase in their activity and their quality of life after treatment as well.3
Common side effects are skin and site reactions, such as redness, itching, or pain at the treatment site (for example, the feet/toes). Your feet may be sensitive to heat for a few days after the procedure. Qutenza can also raise your blood pressure in the short term during your treatment.4
Spinal cord stimulator
Another therapy that can be added to your diabetes neuropathy treatment plan includes nerve stimulation. Spinal cord stimulators (SCSs) are made by multiple companies. They typically have been used for people with pain in their arms, legs, or torso that could not be managed in other ways. SCSs were approved for diabetes neuropathy in just the last few years. SCS devices are also called neurostimulators.3
What is a spinal cord stimulator?
An SCS is an implanted device that uses wire leads placed into the epidural space in the spinal cord (the same area where anesthesia is placed during an epidural for childbirth). The leads are connected to a pulse generator placed under the skin along your back or buttocks.3
SCSs give either a low-frequency or high-frequency pulses. Some devices allow you to adjust the intensity of the electrical current you get. There are different companies that make SCSs, and they each have different benefits and drawbacks. So, reviewing ALL your options with your neurologist is important.3
Before an SCS is implanted, you'll do a week-long trial of the device. This gives you and your neurologist a chance to see its impact on your neuropathy.3
Benefits and side effects of spinal cord stimulators
Implanting a SCS takes about 1 to 3 hours, according to one of its makers, Medtronic.5
There's a chance of infection or reopening at the site where it's implanted. These risks are higher if your blood sugars are too high during surgery. Ask the provider doing the procedure about their surgical outcomes. Ask how many people they operate on have complications or infections, and how they handle those events.3
Another piece to consider is the long-term impacts of SCSs on pain relief. Many studies have focused on the short term (a year or less). One study showed that while nearly 80 percent of people continued to use their SCS after 5 years, only around 50 percent continued to have improved pain relief, compared to 86 percent at the 1-year mark.3
When using either low- or high-frequency SCS, more than three-fourths of people had a 50 percent or more reduction in pain. Sleep, quality of life, and satisfaction of using the device improved.3
The benefits of high-frequency SCS seemed to remain after the 6- and 12-month periods. It declined starting at the 6-month mark for the people using the low-frequency SCS. Still, with either option, over half of people reported their diabetes neuropathy pain was improved at 1 year.3
Discover all of your potential options
Talk with your doctor or healthcare team about all the potential neuropathy pain treatment options that might be suitable for your individual needs.
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