Must I take both meds for my diabetic foot pain?

1 answer | Last updated: Oct 27, 2016
A fellow caregiver asked...

I am a type 2 diabetic, age 61 and I am taking Metanx, supposedly for neuropathy pain in my feet but I also take Cymbalta. I see it is also for this pain. Do I need to take both? Isn't there some kind of topical creme that I can use on my feet? Metanx and Cymbalta are both so expensive. Please give me your thoughts.

Expert Answers

Theresa Garnero is clinical nurse manager of Diabetes Services at California Pacific Medical Center in San Francisco.

Metanx and Cymbalta work in different, yet synergistic ways.

Metanx increases the amount of nitric oxide, an important messenger molecule that helps increase blood flow. Improved circulation helps peripheral neuropathy. Symbalta reduces the perception of pain, and for anyone who has suffered the pain of neuropathy, that is a very good thing. Topical creams are available (such as Capsaicin and others), yet less effective.

The intent of your question was mainly about the expense of the pills. My suggestion is to ask your pharmacist about prescription assistance programs offered by Metanx and Cymbalta. If you qualify, that can help defray the cost.

The other consideration may seem somewhat radical - and possibly covered by insurance: have the neuropathy addressed surgically. Plenty of severe cases of neuropathy have been reversed by a technique that a skilled surgeon uses to clip the area that constricts the nerve branches. This is done on an outpatient basis and requires a small incision. That is a definitive solution. You can learn more by checking out the Dellon Institute. The surgeon that I have heard speak on the subject and who has expert knowledge with many, many success stories is Dr. Ziv Peled (located in San Francisco).

Hope this helps. T. Garnero, APRN, BC-ADM, MSN, CDE