LVPG–Pain Medicine Offers Treatment for Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy of the feet is potentially debilitating and progressive condition that affects millions of individuals who may describe their pain as walking on broken glass, burning or electric shock sensations.

LVPG–Pain Medicine specialists have reported good results from a treatment which uses 8 percent prescription-strength capsaicin (a chemical compound isolated from chili peppers) delivered directly through the skin through patches applied to the feet.

LVPG Pain Medicine specialist Laura Deschamps, DO, has had success using this treatment over the past year, particularly for people with chronic pain or multiple coexisting conditions of the spine and feet.

“Patients with diabetic peripheral neuropathy are often on numerous medications,” she notes. “[This treatment] offers a chance for relief with no drug-drug interactions.”

Diabetic peripheral neuropathy is a result of damaged nociceptive nerve fibers that have a particular pain receptor, TRPV1 (transient receptor potential vanilloid), which are normally activated in response to heat.

The treatment Dr. Deschamps is using directly targets these receptors with capsaicin, a selective agonist for the TRPV1 receptor, increasing the receptor activity and leading to desensitization of the nerve fibers that trigger pain. When applied to the skin, the treatment penetrates through the epidermal layers and results in a reversible ablation of the TRPV1-expressing fibers, suspending the pain signals to the brain. Over time, the nerve fibers may regenerate and re-innervate the epidermal layers, resulting in the return of pain. In this case, the treatment can be re-applied.

“[This] treatment is a simple, straightforward application that takes about 30 minutes,” Dr. Deschamps says. The procedure involves applying a topical anesthetic to reduce discomfort, then applying the treatment, which provides a slow release, concentrated dose of capsaicin through the skin, and then removing the treatment and applying a cleansing gel. Individuals are instructed to use ice packs for any post-procedure discomfort.

“Patients may require a few days to feel relief, which usually lasts at least three months,” Dr. Deschamps says. “They often report experiencing a cumulative effect with subsequent treatments.” Dr. Deschamps notes that this treatment also can be used for post-shingles nerve pain (postherpetic neuralgia). In that case, the treatment time is 60 minutes, and it can also be re-administered every 90 days.

“We want to get the word out to family physicians and podiatrists that [this treatment is effective and can provide significant, sustained relief],” she says. “It’s appropriate for any patient who has tried and failed with other therapies or as a first-line treatment.”