What are the treatment options for peripheral neuropathy of the feet?

From the Guidelines

Treatment of feet neuropathy should prioritize a multi-faceted approach, including optimizing glucose control, using first-line medications such as pregabalin or duloxetine, and implementing proper foot care, to improve symptoms and quality of life. The management of feet neuropathy involves several key components, including:

• Optimizing glucose control to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow the progression of neuropathy in patients with type 2 diabetes 1
• Assessing and treating patients to reduce pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy, and to improve quality of life 1
• Using first-line medications such as pregabalin or duloxetine for neuropathic pain in diabetes 1
• Implementing proper foot care, including daily inspection, wearing comfortable shoes, regular moisturizing, and keeping blood glucose well-controlled if diabetes is the underlying cause
• Considering physical therapy, transcutaneous electrical nerve stimulation (TENS), and lifestyle modifications like regular exercise and smoking cessation to improve symptoms Some of the commonly prescribed treatments for painful diabetic peripheral neuropathy include:
• Anticonvulsants such as gabapentin (starting at 300mg daily, gradually increasing to 300-600mg three times daily) or pregabalin (starting at 75mg twice daily, increasing to 150-300mg twice daily as needed) 1
• Antidepressants like duloxetine (60-120mg daily) or amitriptyline (10-25mg at bedtime, increasing gradually) 1
• Topical treatments such as capsaicin cream (0.075%) or lidocaine patches (5%) for localized relief 1 It is essential to note that treatment duration varies based on the underlying cause, with some patients requiring long-term management. Additionally, recognizing and treating autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life 1.

From the FDA Drug Label

1. Indications and Usage Pregabalin is indicated for: Management of neuropathic pain associated with diabetic peripheral neuropathy Management of postherpetic neuralgia Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older Management of fibromyalgia Management of neuropathic pain associated with spinal cord injury

Treatment of Feet Neuropathy: Pregabalin is indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy, which can include feet neuropathy.

• The recommended dose for this condition is not explicitly stated in the provided text, but it is mentioned that the maximum recommended dose was established in clinical studies.
• Key points to consider when treating feet neuropathy with pregabalin include:
  • Efficacy was established in clinical studies with patients who had a diagnosis of painful distal symmetrical sensorimotor polyneuropathy for 1 to 5 years.
  • Patients recorded their pain daily in a diary, and treatment with pregabalin statistically significantly improved the endpoint mean pain score and increased the proportion of patients with at least a 50% reduction in pain score from baseline.
  • Adverse reactions, such as dizziness and somnolence, were more commonly reported by subjects treated with pregabalin than by subjects treated with placebo. 2

From the Research

Treatment Options for Feet Neuropathy

• Pharmacological treatments are recommended for pain management in diabetic peripheral neuropathy (DPN), with anticonvulsants like pregabalin and gabapentin as the preferred first-line treatment 3, 4, 5, 6, 7
• Other first-line treatment options include duloxetine, amitriptyline, and venlafaxine 3, 4, 5, 6, 7
• Topical agents like capsaicin and isosorbide dinitrate are also useful in treating DPN and may be considered for second or third-line treatment 3, 4, 5, 6, 7
• Opioids and related drugs are suggested for short-term use during acute exacerbation of pain, but should generally be avoided due to potential side effects and lack of long-term benefit 3, 4, 5, 6, 7

Non-Pharmacological Treatments

• Exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation (TENS) have shown promise in reducing pain in patients with diabetic neuropathy 4, 5, 6, 7
• Spinal cord stimulation (SCS) has been found to be effective in treating painful diabetic neuropathy (PDN) refractory to conventional medical therapy 5, 6, 7
• Peripheral transcutaneous electrical nerve stimulation is well-tolerated and inexpensive, but benefits are modest 4

Novel Therapies

• Current research is exploring alternative pain management treatments, including targets such as NMDA receptor and the endocannabinoid system 6
• New treatments, such as palmitoylethanolamide and endocannabinoid targets, show promising results, but require further clinical trials 6