Diabetic peripheral neuropathy is the most common long term complication of diabetes, with a lifetime risk that exceeds 1 in 2 people with diabetes. For some it is silent numbness; for others it is burning, tingling, electric or stabbing pain in both feet that is worst at night and can climb into the legs. The most common question people ask is whether it can be reversed. The honest answer is mixed: established nerve damage rarely heals fully, but progression can be slowed, symptoms can improve, and pain is treatable, although current medicines leave many people with only partial relief. This guide explains what can and cannot recover, why the feet are affected first, the treatments guidelines recommend, why opioids are not one of them, and the research testing new non opioid pain medicines for people who have lived with this pain for months.
Burning or shooting pain in both feet for months?
This study is testing a new non opioid medicine to ease diabetic nerve pain in the feet and legs.
What diabetic neuropathy is, and why it starts in the feet
Years of high blood sugar damage peripheral nerves and the small blood vessels that feed them. The longest nerves, the ones that run to the toes, are affected first, so symptoms usually begin in both feet and slowly move upward, later sometimes reaching the hands, in what doctors call a stocking and glove pattern. It can cause numbness and loss of sensation, pain, or both. Up to half of people with diabetic neuropathy have no symptoms at all, which is why yearly foot checks matter: without feeling, a small injury can turn into an ulcer. Others have painful neuropathy, with burning, tingling, pins and needles, or sharp shooting pain, often disturbing sleep. Our neuropathy clinical trials page covers other causes of neuropathy as well.
Can diabetic neuropathy be reversed?
Once nerves are significantly damaged, they rarely recover completely, and no medicine has been proven to regrow them. But that is not the whole story. The most important finding in this field comes from a landmark 1993 study in type 1 diabetes, which showed that tight blood sugar control reduced the risk of developing neuropathy by about 60 percent. In type 2 diabetes the effect of blood sugar control is smaller, and the American Diabetes Association also recommends optimizing weight, blood pressure, and cholesterol to reduce the risk or slow the progression of neuropathy. Symptoms can improve when blood sugar is brought under control, though some people notice a temporary flare of pain when control improves quickly. It is also worth ruling out other causes that can be treated, such as vitamin B12 deficiency, which is more common in people taking metformin, thyroid problems, or heavy alcohol use. In short: the damage is mostly permanent, the course is not fixed, and the pain is treatable.
What helps the pain: non opioid medicines
American Diabetes Association standards recommend four types of medicine as initial treatment for nerve pain in diabetes: gabapentinoids (gabapentin and pregabalin, sold as Lyrica), serotonin and norepinephrine reuptake inhibitors such as duloxetine, tricyclic antidepressants such as amitriptyline, and sodium channel blockers, and combinations can add relief. A high strength capsaicin patch is FDA approved for diabetic foot pain, and some nerve stimulation devices are approved or cleared for it too. Two practical points matter. First, these medicines typically reduce pain by around a third to a half rather than eliminating it, so expectations should be realistic. Second, a 2026 analysis of real world prescribing found that most people starting gabapentin, pregabalin, or duloxetine for this pain received doses below recommended levels and never had them increased, so if your medicine is not helping, asking whether the dose is right is a reasonable first step. Never change a dose on your own.
Why opioids are not the answer
The American Diabetes Association does not recommend opioids, including tramadol and tapentadol, as first- or second-line treatment for diabetic nerve pain, because evidence for long term benefit is limited and the risks of dependence and other harms are significant. Yet opioids are still prescribed to many people with this pain, which is a sign of how much a better non opioid option is needed. If you take opioids for neuropathy, talk to your doctor before making any change.
Our guide to chronic pain treatment options covers other approaches
How to find a diabetic neuropathy pain study
AllClinicalTrials.com lists neuropathy studies recruiting across the US, and you can filter by location before applying. Right now that includes a study of an investigational non opioid pain medicine for adults with painful diabetic neuropathy in both legs, for people 18 to 80 with type 1 or type 2 diabetes who have had leg or foot pain for about 9 months or more. The application takes about 5 minutes: you answer questions about your diabetes, your pain, and the medicines you take for it, and if the study near you looks like a match, the research team contacts you. Nothing is decided until you have gone through informed consent, and participation is voluntary at every step.
Three things to have ready: when your foot or leg pain began, the medicines you have tried for it and whether they helped, and whether you have taken any opioid pain medicine in the past 3 months.
Common questions
Can diabetic neuropathy be reversed? Established nerve damage rarely heals completely, but progression can be slowed with good blood sugar, blood pressure, weight, and cholesterol control, symptoms can improve, and pain can be treated. Ruling out other causes such as vitamin B12 deficiency is also important.
Why does diabetic neuropathy start in the feet? Because the longest nerves, which reach the toes, are the most vulnerable to damage from high blood sugar. Symptoms usually start in both feet and move upward over time.
Does gabapentin work for neuropathy? It helps many people, typically reducing pain partially rather than completely. If it is not helping, the dose may be too low, and your doctor can adjust it or switch or add another medicine.
Are opioids used for diabetic nerve pain? The American Diabetes Association does not recommend them as first- or second-line treatment, because long term benefit is unproven and the risks are significant. Do not stop an opioid suddenly; talk to your doctor first.
Can diabetic neuropathy cause pain in the legs, not just the feet? Yes. It usually starts in the feet and can extend up the lower legs, and later sometimes the hands. Pain in both lower limbs is typical.
Do diabetic neuropathy trial participants get paid? Some studies offer compensation for time and travel, and study related care is typically provided at no cost to participants. Compensation varies by trial and is always described during the informed consent process before you agree to anything.
See Diabetic Neuropathy clinical trials recruiting now
Browse open studies, filter by location, and apply in about 5 minutes: Diabetic Neuropathy Clinical Trials.