Should We Consider Alternative Therapies
for Diabetic Pain Management?

Jarrod Shapiro, DPM Practice Perfect Editor Assistant Professor, Dept. of Podiatric Medicine, Surgery & Biomechanics College of Podiatric Medicine Western University of Health Sciences, St, Pomona, CA

It is axiomatic that disease processes with a very large number of therapeutic options are usually those in which no one treatment is fully effective. This is certainly true when considering the treatment of diabetic neuropathic pain. In fact, managing the pain associated with diabetic peripheral neuropathy can be challenging in the best of situations. Consider the following list of some of the medications currently used to treat diabetic peripheral neuropathy in the United States:

This incomplete list, including only well-known pharmacologic treatments (not even listing the numerous opioids and other pain medications), demonstrates the difficulty managing the pain of diabetic neuropathy. If any single one of these options were successful a significant amount of time, we wouldn’t need any of the others. Are there other options?

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Not So Alternative Therapies

If the conventional therapies leave something to be desired, perhaps it’s time to more fully consider alternative therapies. In fact, I would suggest the “alternative” approaches need to be added to the list of possible treatment options. Certain medications in this class are already becoming increasingly used. One example is Metanx®, an oral supplement containing L-methylfolate, pyridoxal 5-phosphate, and methylcobalamin. This medication increases nitric oxide production, limiting endothelial dysfunction and subsequent nerve damage.  Another alternative option is alpha-lipoic acid, which increases reduced glutathione, an important antioxidant (Vallianou, et al. 2009). Neuragen PN, a homeopathic drug containing multiple substances, was shown in a randomized controlled trial to decrease pain associated with all cause peripheral neuropathies (Li 2010).  The list of treatment options goes on. Listed below are other alternative treatment options for recalcitrant neuropathic pain:

Even this list is grossly incomplete. As with all medical treatments, not all of these medications and therapies have been fully tested, and we’re likely to find out that some of them are no more effective than placebo. This is where rigorous scientific testing is necessary. However, we should not turn away from these alternative approaches simply because they do not fit into the standard allopathic medical model. Alternative therapies should neither be taken as gospel nor taken for granted.

Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum. Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

References:

• Li L. BMC Complementary and Alternative Medicine, 2010; 10: 22-29.
• Vallianou N, et al. The Review of Diabetic Studies, 2009; 6(4): 230-236.

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