Relief from Pain: Treating Peripheral Diabetic Neuropathy with Topical Compounds

Relief from Pain: Treating Peripheral Diabetic Neuropathy with Topical Compounds

i-briefcaseDiabetes affects the lives of more than 29 million Americans, with an estimated 8 million more undiagnosed.1 For the 10 to 20 percent of Type 2 diabetes patients who also suffer from peripheral diabetic neuropathy (PDN), add “chronic and severe pain” to the list of ways diabetes has changed their lives. A condition in which high blood sugar damages nerve fibers throughout the body, most commonly in the extremities such as hands and feet, PDN sufferers require treatment for the pain, and one of the most effective and lowest-risk treatment options is a topical compound.

Treating neuropathic pain related to diabetes can often be a complicated process for clinicians, physicians and patients, involving trying out various types of treatments with often unsatisfactory results. Traditionally, patients are prescribed a number of different systemic treatments for PDN, including tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, analgesic acetaminophen and nonsteroidal anti-inflammatories (NSAIDs).

Many of these treatments are intended for treatment of depression, convulsions and other unrelated maladies, and they often come with undesired side effects. The American Association of Family Physicians rates all systemic treatment options with a “B” evidence rating, meaning that there is “inconsistent or limited-quality patient-oriented evidence,” but they continue to be the recommended treatment for peripheral diabetic neuropathy, including in the American Society of Pain Educators’ general guidelines.2

Straight to the Pain, Fewer Side Effects

Providers seeking non-systemic treatment options to relieve patients’ PDN pain should also consider topical compounds such as capsaicin or one containing lidocaine, often in patch form.3 Treating PDN with a topical ensures delivery to the localized pain area without cutaneous or systemic uptake, so patients have a lower likelihood of suffering side effects or other complications. Most PDN sufferers experience severe pain in their hands and feet, so compounded medications in the form of creams, patches or medicated plasters can be easily applied directly to the affected foot or hand, relieving pain.

Topical compounds can step in where systemic treatments have failed, especially for patients who show poor reactions to certain treatments. In a study referenced by Podiatry Today, a topical containing five percent lidocaine in a patch or medicated plaster showed a 65-66 percent favorable response from patients, showing the compounded topical was as successful at treating PDN as pregabalin prescribed orally.

In further case studies using a cream of 2 percent lidocaine, 2 percent prilocaine, 2.5 percent topiramate and 0.09 percent meloxicam, several patients who showed adverse or no clinical reaction to systemic treatments reported reduced pain on the compounded topical. A 71-year-old male patient with Type 2 diabetes and painful neuropathy who had failed other treatments changed his Visual Analog Scale pain level from 6/10 to 3/10 after using the topical compound for four weeks. A 55-year-old female patient reported being unable to live her normal life due to pain rated at 10/10 on the scale, caused by painful diabetic neuropathy in her feet. After applying the compounded topical four times a day for six weeks, she reported her pain level at 2/10. No side effects occurred for either patient throughout the study.4

Compounding Specifically for PDN Patients

Of course, not all patients will show poor reactions to systemic treatments and not all patients will show incredible results on a compounded topical like the two patients in the case study. Compounded topicals are intended to provide that customized option for patients who prefer or require a treatment created for their needs.

When compounding topical treatments, considering the individual patient is paramount. Peripheral diabetic nerve pain disproportionately affects older diabetes patients, with up to 50 percent of seniors with Type 2 diabetes being affected by PDN pain.5 Additionally, African American, Mexican American, American Indian, Pacific Islander and Asian American patients have higher risk for Type 2 diabetes. Taking into account the patient’s racial and ethnic background when compounding topicals for PDN treatment can increase the chances of success in pain reduction and lower the already-low risk of side effects.

Things to Know about Topical Compounds in PDN Treatment

No treatment for PDN pain is a sure bet. So many systemic and topical solutions have been listed in medical journals, evaluated in studies, prepared by pharmaceutical companies and tested by patients exactly because there is no magical treatment for this particular neuropathic pain. For some patients, systemic treatments will work best and be worth dealing with side effects. For many others, a custom compounded topical treatment will be both more effective and much easier on their system, especially for older patients. The American Association of Family Physicians gives all PDN treatments, systemic or topical, its “B” rating to indicate inconsistent or low-quality data available.

As there are more clinical studies and more data gathered, however, qualitative patient evidence in the form of case studies and self-reports clearly indicate that when a compounded topical works for a patient, it is extremely effective. And unlike systemic treatments, a compound topical medication for PDN treatment doesn’t come with potentially highly adverse side effects. Some patients reported minor skin rashes or faint burning sensations.

As with treatment for all pain, the goal of pain management is to improve quality of life and function for patients. Compounded topicals can accomplish both for sufferers of diabetic nerve pain, without systemic toxicity. Data for all forms of PDN treatment is limited, and compound topicals represent a much lower-risk option for clinicians and patients, especially if first-, second- or third-line treatments show no results. Not being able to use hands or feet due to severe pain, in addition to the daily challenges of diabetes, can be devastating. When prescribing treatments to give your patients a better life with less daily pain, consider topical compounds.

Pharmaceutica North America provides the highest-quality in-office compound pharmaceuticals. For the treatment of PDN pain, PNA’s Tramadol opioid analgesic can be compounded for treatment of severe and chronic pain, such as that from PDN. Pharmacists and compounding pharmacies can also procure in-office compounding kits for compounding topicals for PDN pain. Contact us to learn more about treatment of chronic and severe pain from PDN.

Show 5 footnotes

  1. “2014 National Diabetes Statistics Report,” May 15, 2015,
  2. “Treating Diabetic Peripheral Neuropathic Pain,” July 15, 2010,
  3.  “Treatment of Painful Diabetic Neuropathy,” 2011,
  4.  “A Closer Look At Pharmacologic Compounds for Painful Diabetic Peripheral Neuropathy,” January 27, 2014,
  5.  “Management of Diabetic Peripheral Neuropathy,” January 2005,

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