Exploring Complementary Therapies for DPN: Alternative Approaches to Relieve Pain and Enhance Quality of Life

Alternative therapies like acupuncture, yoga, and herbal and vitamin supplements are gaining popularity for treating diabetes-related peripheral neuropathy (DPN). These treatments focus on reducing nerve pain and enhancing the overall quality of life. It is important to carefully weigh the potential benefits and risks, considering scientific evidence, and make informed decisions about the best DPN management plan with your diabetes care team.

What Are Some Complementary Or Alternative Therapies For Diabetes-Related Peripheral Neuropathy?

Acupuncture – Skillfully performed acupuncture with thin needles is considered a noninvasive approach that can help treat motor nerves affected by DPN with fewer side effects than drugs may have. The technique used in acupuncture is vital. Trained professionals know how to use the correct technique tailored to each person and adjust the technique as needed as therapy progresses. People treated with acupuncture for DPN report feeling more relaxed, some experience improvements in daily activities and overall well-being, and some may find that pain decreases. Most people start with one or two sessions each week, with the frequency adjusted based on how the individual responds to the therapy.

Massage therapy – Massage therapy can help ease muscle tension and promote well-being, providing a holistic approach to enhancing both physical and emotional health. Regular massage therapy sessions have been shown to enhance blood flow, which helps more effectively deliver nutrients and oxygen to affected nerves. The soothing techniques of massage can help provide relief from discomfort caused by DPN.

Hydrotherapy – Another alternative therapy is hydrotherapy, which involves water exercises that promote circulation, especially in the extremities, where DPN is often worse. Including regular exercise of varied types into your routine can improve overall vascular health and support nerve function recovery. Exercise in the water may be easier for those with DPN to perform.

Physical activity – Physical activity can offer significant benefits for those living with DPN. Strengthening exercises, such as low-resistance training, focus on building muscle without adding stress. This allows muscles to grow stronger at a gentle pace. Isometric exercises help maintain muscle tone without requiring movement, which can be ideal if you have pain or limited mobility. Pilates is a mind-body exercise that involves a series of controlled movements that target the core muscles, improve flexibility, and promote balance, posture, and strength. Pilates can be done at home or in a fitness center and can be suitable for beginners and people with health conditions. It enhances the body’s center of support and improves overall muscular health. Maintaining joint flexibility and gentle stretching routines play a vital role in managing DPN symptoms by keeping muscles long and joints mobile, reducing stiffness and discomfort.

Balance improvement –  Balance issues are common with DPN, so therapies targeting balance are important.

• Tai Chi is one such therapy recommended to improve coordination and steadiness on your feet. Tai Chi features slow, deliberate movements perfect for maintaining joint mobility without causing strain or discomfort in those with neuropathy. These gentle exercises improve balance and proprioception, which are key in reducing the likelihood of falls. Practicing Tai Chi outdoors, when possible, enhances its mental health benefits even further by connecting you with nature and promoting relaxation in a peaceful environment.
• Also helpful are tools like stability balls or balance boards during exercise routines, which can further aid in enhancing balance. Vestibular rehabilitation exercises under professional supervision can also help improve balance.

Herbal supplements – Herbal supplements offer natural treatments for DPN.

• St. John’s Wort is known for its nerve repair qualities and may help damaged nerves heal.
• Ginkgo Biloba could enhance nerve function, too, by improving blood flow, benefiting nerve cells.
• Turmeric is an herb with anti-inflammatory properties that may benefit nerve health.

When using herbal supplements, it’s crucial to consult a professional, such as a Registered Dietitian Nutritionist (RDN), knowledgeable about herbal supplements, dosages, and brands to use. Taking the correct amount is important for safety and effectiveness, and exceeding recommended doses can lead to adverse effects. Be aware that supplement potency differs by brand. Always let your diabetes care team know about any supplements you are taking.

Vitamin therapy – Vitamin therapy may be considered to address nutritional deficiencies that can worsen nerve damage. Replenishing essential vitamins and nutrients may aid in nerve repair and function, offering a holistic approach to managing DPN symptoms. Vitamins B, D, and E are key players in nerve health and help maintain nerve function. Antioxidants in these vitamins protect nerves from damage. If your body is deficient in these nutrients, it can make neuropathy worse. For example, vitamin B12 is vital for healthy nerves. It aids in forming the myelin sheath around nerves, which ensures efficient signal transmission. A lack of B12 might cause tiredness or problems with memory and concentration. Blood tests are recommended before starting B12 supplementation as part of alternative therapies for DPN. Vitamin D supports the overall health of the nerves. Low levels can lead to discomfort and weakness. Vitamin E is an antioxidant that defends against oxidative stress. Before starting vitamin supplements, it’s wise to talk to an RDN. They can advise on individual supplement needs accounting for your nutritional intake. RDNs can recommend supplements from trusted brands that follow strict manufacturing standards for safety and quality assurance reasons. As with herbal supplements, taking too much of any supplement can be harmful.

Mind-Body Techniques – Incorporating mind-body techniques such as meditation and yoga into your neuropathy treatment regimen can help reduce stress, improve mental well-being, and complement other therapies for a holistic approach to relief.

• Meditation can be a powerful tool for those living with neuropathy because it can target the perception of chronic pain. By focusing the mind, meditation helps manage pain levels. Mindfulness practices also lessen stress-related symptoms. For best results, meditate regularly. Patients find that consistent meditation leads to ongoing relief, including fewer episodes of intense pain. 
• Yoga helps people with neuropathy by reducing stress and making their muscles stronger, which is important for managing symptoms. Some yoga poses are designed for people with limited movement. It’s important to work with instructors who understand DPN challenges so they can guide you through safe and effective poses.

Stress Reduction – Lowering stress may be helpful in managing neuropathy symptoms.

• Aromatherapy with scented oils such as lavender can help you relax, easing nerve pain by reducing stress. Peppermint oil cools the skin and lessens mild pain when used on your body. Always mix essential oils with a carrier oil to avoid skin irritation and use them safely.
• Guided imagery – Other stress reduction techniques include guided imagery, picturing peaceful scenes, and meditation.
• Deep breathing is an effective way to manage stress. Sit in a quiet place with few distractions, with your spine erect so your breath can flow without restriction. Take three deep breaths through your nostrils. Next, count to 5 on the inhale, hold your breath for a count of 3, and count to 6 as you exhale slowly through the nose. Do this several times and notice the movement of your belly and ribs as you breathe. Start with short durations consistently and gradually increase the time as you become familiar and comfortable with the practice.

TENS – Transcutaneous Electrical Nerve Stimulation (TENS) is a method to manage nerve pain without drugs through the use of a mild electrical current. It uses a small, battery-operated device to send small electric shocks through the skin, which block pain messages to the brain. It has leads connected to sticky pads called electrodes. The user can adjust the pulse amplitude, frequency, duration, and pattern of the currents. As with all alternative therapies, it is advised to consult a healthcare provider or your diabetes care team before trying TENS. They can advise on proper use and potential benefits for your specific condition.

Chiropractic Care – Chiropractic care is another approach to consider for DPN symptom management. Chiropractic care may help address structural issues. Spinal adjustments can relieve nerve pressure points and may lessen the pain from neuropathy. It’s essential to choose a chiropractor who knows about nerve conditions, as adjustments must be gentle for those with neuropathy, and the approach should be tailored to your needs.

Using multiple alternative therapies together may help with various aspects of neuropathy more effectively than one treatment alone. These treatments address physical symptoms, correcting nutrient deficiencies, reducing stress, and improving overall well-being and quality of life. If you’re considering complementary therapies for DPN, start by discussing these options with your healthcare provider to find an approach that best supports your unique health needs.

Learn more about the Medtronic spinal cord stimulator.

References

Goodwin B, Chiplunkar M, Salerno R, Coombs K, Sannoh U, Shah V, Averell N, Al-Shebab U, Janora D. Topical capsaicin for the management of painful diabetic neuropathy: a narrative systematic review. Pain Manag. 2023 May;13(5):309-316. doi: 10.2217/pmt-2023-0006. Epub 2023 Jul 12. PMID: 37435696.

Baute V, Zelnik D, Curtis J, Sadeghifar F. Complementary and Alternative Medicine for Painful Peripheral Neuropathy. Curr Treat Options Neurol. 2019 Sep 2;21(9):44. doi: 10.1007/s11940-019-0584-z. PMID: 31478093.

About the Author

Janice MacLeod, MA, RD, CDCES, FADCES,  is a diabetes-cardiometabolic consultant and thought leader in digital health and chronic condition management. Janice began her career as a diabetes-focused dietitian and certified diabetes care and education specialist at Carilion Clinic in Roanoke, VA and later at the University of Maryland in Baltimore, MD. More recently, Janice led clinical advocacy at Medtronic and Companion Medical and has served in clinical leadership roles with Welldoc and Johnson and Johnson. She is past chair of the Academy of Nutrition & Dietetics Diabetes Practice Group and has been elected to the Association of Diabetes Care and Education Specialists Board of Directors (2024-2027). Janice has authored multiple publications and developed numerous programs on diabetes nutrition, digital health, and practice transformation.  Her passion is developing business-savvy solutions leveraging technology to transform care.