Millions of people living with diabetes experience nerve damage causing burning, tingling or shooting pain – a complication known as diabetic neuropathy. While there is no cure, there are many ways to slow nerve damage and ease discomfort. The key is to work closely with your healthcare professional and combine medical therapies with lifestyle and self-care strategies.
**Control the underlying disease**
Keeping blood sugar and blood pressure within targets helps slow nerve damage and may even improve symptoms. A balanced diet rich in vegetables, fruits and whole grains, regular exercise (at least 150 minutes of moderate activity per week) and quitting smoking all support nerve health. Good foot care – wearing supportive shoes, inspecting your feet daily and addressing sores promptly – reduces the risk of further injury.
**Medications for neuropathic pain**
Several prescription drugs can dampen nerve pain. Anti-seizure medicines such as **pregabalin (Lyrica)** and **gabapentin (Neurontin)** are often first-line and are recommended by the American Diabetes Association. Serotonin-noradrenaline reuptake inhibitors (SNRIs) like **duloxetine (Cymbalta)** and **venlafaxine (Effexor XR)** are also used, sometimes as a first choice. Tricyclic antidepressants such as **amitriptyline** and **nortriptyline** can relieve mild to moderate nerve pain, but they may cause drowsiness, dry mouth or dizziness. If one medicine alone does not provide enough relief, clinicians may combine an anti-seizure drug with an SNRI or add over-the-counter pain relievers and topical anaesthetics such as lidocaine patches.
Updated guidelines suggest trying gabapentinoids (pregabalin and gabapentin) or duloxetine first and adjusting doses carefully. If pain remains severe despite these medications, other drugs may be considered. **Tapentadol** is approved for painful diabetic neuropathy but is an opioid and carries risks, so clinicians use it cautiously. An 8 % **capsaicin** patch is another option when oral drugs fail; it delivers a high-dose chilli-pepper extract that can desensitize pain fibres, though application-site reactions are common. Because long-term opioid use has little evidence of benefit and significant safety concerns, experts advise against routine opioid therapy.
**Beyond medication**
Non-drug approaches can further reduce pain and improve function. **Physical therapy** – including stretching, strengthening and balance exercises – helps maintain mobility and reduces symptoms. For some people with difficult-to-treat pain, **spinal cord stimulation** (SCS) may be an option; tiny electrodes deliver electrical impulses to the spinal cord, blocking pain signals. Studies show that SCS (especially high-frequency 10 kHz stimulation) can provide meaningful relief when conventional treatments fail. These procedures require specialist evaluation and are usually reserved for severe cases.
**Lifestyle changes that make a difference**
Simple daily habits can have a big impact on neuropathic pain. Regular low-impact exercise such as walking or swimming improves circulation and reduces nerve pain. Maintaining a balanced diet and healthy weight stabilizes blood sugar and may lessen symptoms. Wearing comfortable, well-fitting shoes protects sensitive feet and minimises irritation. If you smoke, ask your healthcare provider about resources to help you quit; tobacco reduces blood flow to nerves and delays healing.
**Exploring alternative and complementary therapies**
Several natural or non-invasive therapies may provide additional relief. **Capsaicin cream**, **alpha-lipoic acid** and **acetyl-L-carnitine** supplements have shown some benefit in small studies, although results vary. **Acupuncture** involves inserting fine needles to release endorphins and improve circulation; it may help some people. **Transcutaneous electrical nerve stimulation (TENS)** and **transcranial magnetic stimulation (TMS)** use electrical or magnetic pulses to disrupt pain signals and are being studied as non-drug options. Always discuss these therapies with your healthcare professional to ensure they are safe and won’t interfere with other treatments.
**Putting it all together**
Diabetic neuropathic pain is complex, but relief is possible. Combining good diabetes management, first-line medications like pregabalin or duloxetine, non-drug therapies such as physical therapy, and healthy lifestyle habits often provides significant improvement. If you don’t get adequate relief, specialist-guided options like spinal cord stimulation or capsaicin patches may help. Work closely with your healthcare team to design a personalized plan – the right combination of treatments can help you regain comfort and quality of life.
