The most common cause of peripheral neuropathy in all patients is diabetes. Diabetic neuropathy can result in pain and numbness in the legs and arms, hypoglycemia unawareness, difficulty standing and sitting, along with many other symptoms. The best way to treat and prevent diabetic neuropathy is to effectively manage blood sugar levels. While working on managing diabetes, there are multiple treatments available from a compounding pharmacy to provide symptomatic relief for neuropathic pain.

What is Diabetic Neuropathy?

There are multiple types of diabetic neuropathy that affect the body differently.

Peripheral neuropathy: This is the most common form of diabetic neuropathy. It results in pain that is described by patients as burning, stabbing, or tingling in the arms, legs, hands, and feet. There can be numbness, feelings of heat or cold, or a pinprick sensation. Topical medications are most effective for this type of diabetic neuropathy.

Autonomic neuropathy: This type of neuropathy affects nerves that involve the heart and blood pressure along with other essential systems. Symptoms of autonomic neuropathy include indigestion, nausea, dizziness, and sexual dysfunction. It may also result in hypoglycemia unawareness – which means that patients with autonomic neuropathy may not experience usual symptoms of low blood glucose levels.

Proximal neuropathy: This type is more common in those with type 2 diabetes. It can include pain in the thighs, hips, buttocks, and legs along with weakness in the legs. It may result in difficulty sitting and standing.

Focal neuropathy: Focal neuropathy, which is more common in older adults with diabetes, causes acute painful episodes in different areas of the body. It may also lead to problems with vision and cause an inability to focus.

For most patients the pain of diabetic neuropathy worsens at night. The symptoms will continue until the underlying issues of diabetes are managed. Medications can be made for symptomatic relief that can greatly improve quality of life for individuals suffering from this condition. Patients can experience multiple types of neuropathy at different times. However our pharmacy most often compounds topical creams that are used for treating peripheral neuropathy, which is the most common type.

Medications for Treating Diabetic Neuropathy

Neuropathic pain is often treated with medications that were first approved for other uses. These medications usually are available commercially in a form that is meant to be used orally. They do not have FDA approved indications for treating diabetic neuropathy. Neuropathic pain can be better managed with a topical treatment. A compounding pharmacy is needed to make an anti-seizure medication in the form of a cream since this delivery method is not commercially available. Some of the medications made by a compounding pharmacy for treating diabetic neuropathy include:

• Antidepressants: Tricyclics used for treating depression have been shown to reduce neuropathic pain. They manage pain by blocking pain receptors in multiple ways. Tricyclics like amitriptyline are made into creams to be applied topically. Cyclobenzaprine is an antidepressant that is also sometimes used because it has similar effects to tricyclics.
• Anti-seizure medications: Gabapentin is an anti-seizure medication that is used to treat neuropathic pain. When compared to other medications for treating diabetic neuropathy, it has the best balance of safety and efficacy.
• NSAIDS: In general, NSAIDS are not a first-line treatment for neuropathic pain. They are often used in cases where the cause of pain has not yet been determined. NSAIDS decrease pain and inflammation in the body and are frequently used to treat arthritis.
• Lidocaine: Lidocaine is an anesthetic that has many applications in dermatology, dentistry, otolaryngology, and more. It can provide some relief from neuropathic pain by numbing pain receptors.
• Capsaicin: Capsaicin reduces the sensation of pain by stimulating pain receptors. This causes a burning sensation initially followed by a reduction in pain.
• Ketamine: Ketamine blocks NMDA pain receptors to prevent pain transmission. Oral administration results in numerous side effects that can be avoided with topical administration.
• Opioids: The use of high-strength painkillers should be reserved for the most difficult cases because of their numerous adverse affects and high addiction potential.
• Low Dose Naltrexone: A promising treatment for a variety of chronic pain conditions. The low dose version can only be obtained from a compounding pharmacy.

Topical creams for managing neuropathic pain result in less risk of systemic effects compared to orally administered medications. Oral administration of drugs like NSAIDS can result in gastrointestinal side effects along with an exacerbation of some symptoms of diabetes. Creams made by a compounding pharmacy can also have customized dosages based on an individual patient’s needs. The best symptomatic treatment for diabetic neuropathy is a combination cream with proven medications like amitriptyline, gabapentin, and capsaicin. Along with the use of a topical cream it is essential to manage blood glucose levels so that the condition can be reversed as much as possible.