The most IMPORTANT thing to remember is that for any treatment to succeed, CONTROL OF BLOOD SUGARS is PARAMOUNT.
There is nothing like an about normal blood sugar level.
Similarly fluctuations in sugar levels can also lead to failure of treatment.
Positive control through regular HbA1c measurements and regular sugar monitoring reduce the overall risk of neuropathy.
Stopping smoking and alcohol also contribute to decreasing neuropathic pain as does exercise and weight loss.
Apart from these measures which help in slowing the progression of disease, topical applications and oral medication is also used.
Topical applications containing capsaicin, L-arginine, lidocaine etc have been found to be useful in reducing pain.
Oral medications like methylcobalamin, amitryptiline,imipramine, pregabalin, escitalopram etc also have been shown to bring about relief.
The point to understand is that none of the medicines work in all patients, and a regular review and at times many hits and trials later the person may find relief in pain. Inspite of this there is a group of patients who do not get relief inspite of controlling sugars, topical applications and various oral medications and are resistant to treatment of painful neuropathy.