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There are a couple of articles for background info about Diabetes Type 2 Overview and What is Diabetic Peripheral Neuropathy?

Which brings us to -How to treat diabetic peripheral neuropathic pain…

Number 1 treatment:  Blood glucose control!  If the blood glucose levels are kept within range, neuropathy can be slowed and possibly reversed.

In addition, to help with pain…

1.  Antidepressants

• Cymbalta (duloxetine) -typical dosing for DPNP is 60mg once daily.  It is only available in brand only-pricey!
• Elavil (amitriptyline) or Pamelor (nortriptyline) -both come in generic and are well tolerated but can cause drowsiness and general dryness (dry mouth, eyes…)
• Effexor XR (venlafaxine ER) -dosing is usually 15-225mg daily.  Brand only so pretty pricey.
• Celexa (citalopram) and Paxil (paroxetine) -these aren’t used alone but can be added on to other therapy

2.  Anticonvulsants

• Neurontin (gabapentin) -this is the most popular drug to treat DPNP.    It is available in generic.  Gabapentin should be titrated slowly because of side effects like dizziness and sedation.
• Lyrica (pregabalin) -like gabapentin but more potent (and expensive)
• Tegretol (carbamazepine), Lamictal (lamotrigine) and Dilantin (phenytoin) -all can help but aren’t usually used because of the major side effects.

3.  Pain Drugs

• Ultram (tramadol) -works well for pain in general and DPNP -it has pain and antidepressent activity.  Inexpensive and well tolerated.
• OxyContin (oxycodone CR) -major pain medicine -lots of side effects and can lead to addiction but when the pain is bad -it works!

4.  Topical -Lidocaine patches -work well as an add on therapy.  

5.  Natural Remedies

• Capsin (capsaicin) -topical cream that is made from chili peppers!  The big picture is, capsaicin causes enough irritation in the area that the pain receptors are overwhelmed and “shutdown”.
• alpha-Lipoic Acid -an anti-oxidant that helps decrease pain and numbness.  Typical dose is 600mg daily.
• Evening Primrose -500mg up to 8,000mg daily.  Helps nerves function better (more sensation; less pain)
• Borage Oil -1,000 -4,000mg daily.  Works similarly to Evening Primrose
• Acupuncture and Magnet Therapy

We would love to hear your personal experiences!  Please leave us a comment!

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First off, what is neuropathy?   It is a general term used to describe disorders of the nerves. 

Then, what is diabetic peripheral neuropathy?

Diabetic neuropathy is due to high glucose in the blood that leads to nerve damage.  The damage can interrupt the signal traveling from a part of the body (ie foot) to the spinal cord and brain.   The damage can lead to the “pins and needles” feeling, pain and numbness.

People with diabetes also have a higher risk of infection -add this to a numb area on the foot and you have the makings for a serious infection.  Which is why foot care is a big deal for patients with diabetes.  I always tell this story when someone says, “I can deal with some tingling and numbness, what’s the big deal?”

When I was working in the Diabetes Clinic, I met Mr. B.  He had diabetes for many years.  He never really changed his eating/exercise habits and didn’t really keep an eye on his blood sugar.  We discussed some medicine and he started it- begrudgingly.  At this point Mr. B had a little non-painful peripheral neuropathy (just some numbness around the toes).  We did a full foot exam and talked about him (or someone else) checking the bottom of his feet everyday. 

Mr.  B. missed a few appointments over the summer (he was visiting his grandkids).  While away, Mr. B. stepped on a sharp stone -it made a small puncture on the pad of his big toe.  He didn’t feel it because of the numbness.  Fastforward 8 weeks,  Mr. B. comes in for his appointment with great stories about the grandkids.  We do a foot exam, Mr. B. has a serious infection and his right toe is amputated within a few days. 

I asked Mr. B. about the foot exams and he said, he thought it was silly and was embarrassed to ask someone else to look at his feet because sometimes he has trouble seeing the bottom of his feet.

What is it with infections being so serious in people with diabetes?  People with diabetes get infections more easily, heal slower and often don’t feel the warning signs due to neuropathy.

Number 1 way of avoiding diabetic peripheral neuropathy?  Controlled blood sugar levels!

Once a patient has diabetic peripheral neuropathy…

1.  Controlled blood sugars can slow the progression and may actually reverse some of the damage done. 

2.  Foot Care -this includes regular foot examines with a medical professional and checking the bottom of the feet and between the toes daily -for dry, cracked skin, calluses and early signs of infection.  I am, as most healthcare people are, very intense about foot care.  Even wearing socks so that the seam rubs the foot can lead to an infection!

3. Medications -there are no medications to specifically treat peripheral neuropathy.  There are drugs that can help control blood sugar and then there are drugs that can help with the pain caused by neuropathy. 

I will go into the medicines used to treat pain associated with peripheral neuropathy in the next article.

For now, there you have it -a diabetic peripheral neuropathy overview.

Please leave some feedback!

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Here is a quick, quick video comparing generic sumatriptan and the new Sumavel DosePro

As always, we would love to hear from you so please leave a comment!

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So, just to go over some of the benefits of caffeine…

Headaches:  Taking caffeine with pain medication (Tylenol, Alleve, Motrin, etc.) works better than pain meds alone.  Caffeine helps the pain medicine get into the brain faster and more efficiently which leads to better pain relief!

Mental Alertness: Which is why most of us love a cup of joe in the morning!  Caffeine gets into our brain very easily and helps us be wakeful and focused (to a point).  When caffeine is mixed with taurine (like in Red Bull) it has shown a small increase in mental performance.  Even more effective is when caffeine is mixed with glucose (like most energy drinks).

Asthma: Caffeine can help improve airway function in people with asthma up to four hours -this is an FYI!  Definitely don’t take a cup of coffee instead of your inhaler.

Diabetes: Studies have shown that about 300mg of caffeine/day (about 2 cups of coffee) decreases the risk of developing diabetes type 2 by about 20%!

Bloating:Caffeine is a diuretic -it helps you pee some of that extra fluid out -this is why it is one of the ingredients in Pamprin.

Hypotension: People who have low blood pressure -a little caffeine throughout the day can help. 

Gallbladder and Parkinson’s Disease: 2-3 cups of cofee/day can decrease the risk of both gallbladder and parkinson’s disease. 

Weight Loss…not really: Caffeine is thought to suppress appetite, increase calorie burning and promotes water loss -unfortunately studies have shown that caffeine as a weight loss aid is of minimal, temporary benefit .

Some negatives about caffeine:  (just a few)

Caffeine can cause insomnia, nervousness, belly issues/nausea, increased heart rate, headache, agitation.  Caffeine can also worsen depression and anxiety. 

One more negative about caffeine…caffeine withdrawal -I won’t go into it here but you can watch the video Catie did about  caffeine withdrawal.

Small note here about the ultra popular Red Bull and Vodka drink.   I had a couple of people come into the pharmacy and ask…“Can Red Bull and Vodka kill me?”  It sounded funny to me at first but it is actually a really popular concern!  So, here is the dealio -no. 

However, taking in too much caffeine can be fatal (very rare!).  In addition, alcohol (the vodka) will increase the levels of caffeine (from Red Bull) in the body.  Lastly,  taking caffeine while drinking can cause a false sense of alertness so that people may think they are less drunk then they really are -so beware!

There you go a quickie -next time people are dissing on coffee, soda, red bull -go ahead and throw some statistics of the benefits of caffeine at them!

I know there are caffeine lovers out there -drop us a comment!

Also, why not learn How to Save Money on Your Prescription Drugs by watching our *FREE* video series -that way you can afford those expensive lattes!

Halloween was a blast!  The furbabies sported their costumes at a neighborhood parade where furbabies and children contended for 1st and 2nd place prizes based on best costume (it was kid vs kid and furbaby vs furbaby).  Toshia chose to be a French maid this year and Tater Tot begged to be a squirrel (her favorite friends).  They totally got jipped out of a prize due to biased judging!

While this was all going down, we received a message from a reader who was concerned about a tremor he was experiencing after taking the pain medication, Demerol.

Here is the question:

I had a bad reaction to Demerol.  I took 400 mg over 2 days
and discontinued.  My main concern is that on the second day, I had a
tremble of my neck that would cause my head to shake just slightly, it
is probably not noticeable except to me.  After 6 days without this
symptom, I feel like it may have returned.  Could I have caused
permanent neurological damage?  I have not taken any since the second
day and am horrified I may have some permanent, progressive neuro
problems.  Thanks for your time.

Here was my response:

Hey there,

I’m hoping that your situation has resolved by now, but if not then maybe the following information will help.

If I’m understanding you correctly, you had a total of 400mg of Demerol over 2 days (not 400mg per day, right?). Either way, there is no official max dose for Demerol (some resources recommend a max of 600mg per 24 hours) so
you didn’t exceed the “max.”  However, it does sound like the dose you took was too high for your system to handle.

A tremor with Demerol is usually a sign that the drug has built up in your blood stream.  Demerol is broken down into an active component called normeperidine, which takes a while (like days) for your body to get rid of. It takes even longer for your body to remove the normeperidine if your kidneys do not work well.

Perhaps the normeperidine accumulated in your body (for reasons that you would have to discuss with your doctor) and that’s why you experienced the tremor effect days after stopping the medication.

Demerol is not known to cause permanent neurological damage so you should be fine in that department.  If you are still experiencing the tremor, it would most likely be due to some other cause.

End of the response!

If you have found yourself to be in a similar situation as the abovementioned reader was, please share your experience with us by commenting on this post (you can leave a comment below!).  We look forward to hearing from you! 

Also, our FREE video course on how to save money on your prescription drugs is still up for grabs.  Click here to get it! 

Catch ya’ll later.

A topic that receives quite a bit of attention in my pharmacy is the idea of taking NSAIDs (i.e. Advil, Aleve, etc.) and high blood pressure medications together – is it a bad idea or what? 

It’s actually a misconception that the NSAIDs (non-steroidal anti-inflammatory drugs) directly interact with high blood pressure medications.  The patient information on the side of the Advil and Aleve OTC packaging reads that you should talk with your doctor before taking these meds if you have high blood pressure.

Check out my video to find out what the dealio is!

If you have any questions after watching that clip, toss me an e-mail at cate@getpharmacyadvice.com or submit a comment below. 

Make sure you also get your FREE video course on how to save money on your prescription meds by clicking here.

Thanks dudes!

Don’t worry, it was no biggy…just irritating as hell! J

The procedure I had is called a frenectomy – this is where they remove a small fold of tissue named the frenulum.

Let’s describe it this way – (for me they took out the frenulum that was on my bottom lip) it’s the piece or fold of skin that connects your lip to your gum.  You have one on the upper lip, the lower lip, and under the tongue. 

Here’s a picture of the frenulum of the upper lip!

See that fold of skin just above the teeth? That's the frenulum of the upper lip!

The frenulum under your tongue is that fold of skin that seems to be attaching the bottom of your mouth to the underside of your tongue.

Check out my video to get more details on the procedure!  I don’t think you can see me very well because of the lighting, but you’ll get the gist of it. 

What it boils down to is that my lower frenulum was too long so it was pulling the gums that were protecting my bottom two front teeth downward.  The roots of my teeth were becoming exposed (which can end up being pretty painful) and eventually if the problem wasn’t solved, my teeth would’ve fallen out. 

So the Vicodin they gave me…holy crap, that stuff works well!  I pretty much took it at night and only 1 tablet at a time.  I took it at night mostly because by the end of a full day of talking, eating, moving around my mouth the pain was a bit much. 

The Vicodin didn’t make me sleepy at all, but it sure did cut the pain!  I took it at bedtime too because it helped my mouth/jaw relax a little.  Whatever I was doing in my sleep created a wicked painful mouth in the morning, so the Vicodin helped out in that way too!   

And that’s, that!  I think pretty much everything else you can find in more detail in the video portion of this post.  Thanks for reading/listening and don’t forget to e-mail me at cate@getpharmacyadvice.com. 

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I had a lady come in with a prescription for Lodine, and she wanted to know if it was like codeine. 

Makes sense right, the –ine at the end of both of the drug names makes them sound alike.  You would think they’d be related, but they actually are not!

Lodine is part of the class of medications called NSAIDs (Nonsteroidal anti-inflammatory drugs).  You may recognize the names Motrin or Advil (both are brand names for ibuprofen) – they are available OTC and are also part of the NSAID group of medications, so Lodine is very similar to them. 

Unlike Advil or Motrin, you need a prescription to get Lodine.

Lodine is used to treat mild to moderate pain and decrease swelling.

Codeine belongs to the group of narcotic pain medications that are used to treat or prevent moderate to severe pain. 

Codeine DOES NOT help to decrease swelling at all – it is a stronger pain reliever than Lodine, but Lodine has the added benefit of being able to get rid of some swelling that may be causing a problem. 

Lodine has a generic called etodolac, so if you bring a prescription for Lodine to the pharmacy, you will most likely end up leaving with the etodolac in your prescription bottle!

The lady didn’t end up filling her prescription – guess she wanted the good stuff!

Leave a comment and let us know what you are thinking.  Feel free to throw me an e-mail at cate@getpharmacyadvice.com too.

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I have a feeling the injury is going to lead to stiff neck pain, and I immediately thought what can I do to prevent a neck muscle spasm.  So, what’s involved with stiff neck treatment or just muscle pain relief in general?