As many as 50% of individuals with diabetes will eventually develop diabetic neuropathy, or pain related to damaged nerves. A large proportion of these individuals will report pain that is difficult to control, and that leads to disability. While this pain is a huge concern, controlling it shows no clear path to success. The only tried and true method of improving pain or halting the progression of diabetic neuropathy comes from glucose control; however, for many, this is not enough to provide desired relief.
Challenges of Treatments to Manage Neuropathic Pain
Studying potential treatments that could manage neuropathic pain are challenging on their own, as many researchers and clinicians disagree on what the goals of such studies should be, and how those goals should be measured. This has led to slow-moving research, and only a few viable options on the market. Currently, in the U.S., there are three medications approved by the FDA specifically for treating neuropathy. These include pregabalin, duloxetine, and tapentadol. However, none of these have shown complete efficacy in controlling or completely reducing pain, even when taken in conjunction with each other.
Because of this, treatment must be considered on a case-by-case basis, and in a trial-and-error fashion. This can be very frustrating for individuals with considerable pain, and can lead to a desire for something different. Currently the American Diabetes Association recommends that all individuals with type 2 diabetes should be screened annually for neuropathy. When neuropathy is present though, it is often disagreed upon on how to treat it, despite medications being on the market. For example, in Europe and parts of Canada (as outlined by the European Federation of Neurological Societies and the Toronto Expert Panel on Diabetic Neuropathy, respectively), it is recommended to use tricyclic antidepressants, antiepileptic medications, and serotonin-norepinephrine reuptake inhibitors (SNRI’s) off-label as the first line of defense. Stronger medicines like opioids or tramadol are not recommended until further down the line. The American Academy of Neurology, on the other hand, recommends antiepileptic medications first, followed by all others. Regardless of the approach, a common theme is the incomplete treatment and management of debilitating pain.
“Nutraceuticals” For Pain Relief
In order to combat this problem, and in efforts to find something new, many are looking to “nutraceuticals” for pain relief. These include nonpharmaceutical approaches, such as vitamins, vitamin complexes, and other similar components. While there has not been much, if any, clinical research that demonstrates a definitive benefit of nutraceutical approaches, there has been some evidence of overall relief of a broad range of symptoms in many who try them. This could be due to the fact that some vitamin deficiencies, if present in an individual, could actually be causing the neuropathy. These include deficiencies in vitamin D or B-complex vitamins. It would make sense then that adding vitamins to the diet could aid neuropathy greatly. However, on the whole, little statistically significant evidence has been presented in favor of nutraceuticals over other pharmaceutical medications, and there are currently no FDA or EMA approved nutraceuticals on the market specifically for neuropathy.
Let us know what you think; have you tried anything that would be considered a nutraceutical and noticed an improvement? Or have the traditional methods proven to be the best option for at least a fraction of relief?