Botox For Diabetic Nerve Pain

In a recent study found in Neurology (28 April 2009), a group of scientists tested the use of injections of botulinum toxin type A—better known as Botox— into the skin on top of the foot to treat neuropathy pain. In this study, 44% were noted to have significant improvement of their pain after multiple treatments with botox. The question is whether this is a good idea.

Neuropathy pain is problematic and often difficult to treat. For years, people have been told that no treatment is available. If this were truly the case, Botox would be a good option. If it is typical Botox, however, it would require recurrent treatments throughout life to maintain the relief. And there is also a large concern for risks of injecting this substance into the skin of a diabetic without normal nerve feeling.

The truth is, however, that many diabetics are finding relief from their pain from the following options:

Monochromatic Infrared Therapy (MIRE or Anodyne): Infrared light therapy provided at a regimen of 2-3 times a week for 12 treatments. This has been shown in studies to improve some in many individuals, but has also be shown to be ineffective in many individuals.

It stimulates Nitrous Oxide (NO) release from the blood cells that interactes with surrounding tissues and decreases nerve pain, stimulates vasodilation (opening of blood vessels to increase circulation), increases nerve functioning. Often it has been shown to return sensation to a previously numb foot.

Metanx: This is a prescription medical food for the dietary management of endothelial dysfunction in patients with diabetic peripheral neuropathy. Traditional over-the-counter vitamins are synthetic forms of the nutrients found in nature and must be converted to their active forms before they can actually be used by the body's cells for such vital functions as DNA production, cell reproduction and homocysteine metabolism.

B Vitamin Active Form
Folic acid L-methylfolate (2.8mg)
Vitamin B6 Pyridoxal 5'-phosphate (25mg)
Vitamin B12 Methylcobalamin (2mg)

Metanx is a unique formulation providing the active forms of folate, vitamin B6 and vitamin B12 to manage the distinct nutritional requirements of neuropathy patients who often experience numbness, tingling, and burning sensations in their feet. Per studies run by the makers of Metanx, one tablet is equivalent to taking 19 folic acid tablets (1mg each), 2 B12 tablets (1mg each), and 2 B6 tablets (25mg each). You would need to take a handful of over-the-counter tablets to equal one dose of Metanx. Metanx is given at 1 tablet twice a day.

Neuremedy: This is a medical food consisting of benfotiamine, that nourishes dysfunctional nerves allowing them to conduct impulses more normally. Since the early 1960s, benfotiamine has been used successfully to treat neuropathy in Asia and Europe. Has has extensive studies that show it to be both effective and safe. It has recently been brought to the USA for treatment of neuropathy in our population.

Adequate blood levels of the micro-nutrient thiamine (Vitamin B1) are essential for the proper functioning of the nervous system. Recent studies have shown that many people suffering from peripheral neuropathy have low plasma levels of this essential micro-nutrient. They are unable to maintain adequate plasma thiamine levels through normal dietary means, or even through most of the B complex vitamins. They need a more bioactive form of thiamine for their nerves to function properly. In populations like diabetics, the elderly or neuropathy patients from other causes, Neuremedy alleviates the symptoms of peripheral neuropathy by delivering a highly bioactive form of the micro-nutrient thiamine to where it is needed, the nerve cells. Neuremedy works by nourishing the nerves.

Due to its overall efficacy, often people will experience improvement within days of starting the treatments. It does not reduce the symptoms of neuropathy for everyone, but is definitely a viable options. Neuremdy is dosed at one capsule twice a day.

Evening Primrose Oil: This is an herbal medication consisting of an oil from a plant native to North America that has yellow flowers that bloom in the evening. This oil extract contains up to 25% of essential fatty acids including linoleic acid (LA) and gamma-linolenic acid (GLA), an essential fatty acid. Essential fatty acids are required by the body for growth and development, and must be obtained from the diet. This formulation of LA and GLA are effectively absorbed and utilized by the body. At correct dosages, it has been shown to reduce symptoms of neuropathy including numbness, tingling, pain, burning, or lack of sensation.

Evening Primrose Oil is usually dosed at 2000mg (2 grams) daily, but can be increased to 3000mg (3 grams). Precautions include some side effects that are rare and mild, and include nausea, stomach pain, and headache. Stomach pain and loose stools may be indications that the dosage is too high. There are also some reports of seizure induction if a patient has a history of seizure disorders.

For additional information, please visit our website at http://www.utahfootdoc.com/

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com