Question

My diabetic neuropathy is extremely painful, especially at night. I've tried all the meds, including gabapentin (which caused dreadful side effects), but nothing seems to help.

Are there any new treatments on the horizon?
 

Answer

First, you should make sure your diabetes is tightly controlled, as this will reduce any progression of the condition. Then, tell your doctor if you have any depression or insomnia. Both these can make the pain of neuropathy worse, and treating them, if present, should help you a lot.
 

Though you tried gabapentin without success, it's helpful in many patients; maybe you stopped it before it had time to become effective. You have to start low and increase the dose very gradually, to allow a high dose in the range of 2,000 to 4,000 mg daily. Of course, if you get side effects again, you must stop it.
 

A new drug was approved in late 2004: duloxetine (Cymbalta®). This drug decreases night-time pain within 1-2 weeks, and after 5-8 weeks pain intensity is halved. The side effects can include nausea, sleepiness, constipation, and dry mouth. And there's another new drug on the horizon - pregabalin (Lyrica®).
 

Some patients respond to drugs normally used to treat seizures - lamotrigine (Lamictal®) and carbamazepine (Tegretol®) - or high blood pressure - clonidine (Catapres®). And the muscle relaxant baclofen (Lioresal®) helps others.
 

A patch containing a local anesthetic (Lidoderm®) is helpful for some people, but it can cause redness and itching. Finally, you could resort to non-drug therapy: cognitive-behavioral therapy, biofeedback, infra-red light, and transcutaneous electrical nerve stimulation (TENS) have all proved helpful in some patients with painful diabetic neuropathy.

Related Links
FamilyDr.org: Diabetic Neuropathy
NINDS: Diabetic Retinopathy Page