I have had type�2 diabetes treated with Avandia [rosiglitazone] for a year, and although this seems to be helping control my blood sugars, I am having severe pain in my extremities. I realize that this is neuropathy and that I must continue with my regimen, but how can I alleviate the constant pain without yet another drug?

Neuropathic pain is often treated at the request of the patient. If the problem is not serious, some patients prefer not to be treated with medications. If it is more painful, interfering with sleep, and decreasing the quality of life of someone, those would be reasons to treat.

There is no information that treating neuropathy has an effect on the progression. In addition, treatment will not allow for someone to experience sensation that has been lost. Therapies can be divided into those given externally and those where you take medications. External therapies could include the use of a TENS unit or topical capsaicin cream. These treatments are affective when pain is not severe. With more severe pain, especially if it is interfering with sleep, amitriptyline, nortriptyline, and Neurontin have been used. It is discouraged to use narcotics because of the chronic nature of the problem. Over-the-counter pain relievers are generally not very helpful. Finally, optimization of blood sugar control is also a helpful therapy.

JTL

[Editor’s comment: Also, see Diabetes and Foot Pain (at the Diabetes Monitor) for some similar thoughts about the management of painful diabetic neuropathy.

WWQ]