So, I’ve used both the capsaicin cream and the compounded prescription cream, and they both work well. 

Capsaicin

Capsaicin cream was a surprise find. It is based in complimentary western medicine practices. This stuff is  great  because it's cheap and you can have them scattered around—in your car, office, or wherever you need them. ... quick relief.  It is Derived from chili peppers, it provides heat to help manage middle-grade pain and improve sensory feedback. Keep in the car for emergency use (like when you need to ensure you can feel the pedals).

The Cost: $3 to $6

The Heavy-Duty Stuff: Compounded Prescription Cream

A custom-ordered mix (Gabapentin, Ketamine, Lidocaine) designed for pain interruption! As a side note, this stuff is great for a stiff neck. In my experience it works well, most times much better than the capaicin.

The cost: no insurance - $80 to $120

Unless you are in the very small number of people that like to go to the gym, pretty much nobody wants to exercise. Managing neuropathy pain through exercise focuses on improving circulation, managing flexibility, and maintaining whatever strength you have.

I combine PT exercises with the compression boots and some brief walking to get improvements.

Here are three of the most effective exercises (I have found):

• Swimming - I am fortunate to have a community pool and I find leaning towards or back to the wall kick feet and ensure foot is fully extended.

• Walking - This is a tough one depending on your pain level. I have found walking just a short distance to the end of the street and back is super beneficial. I use a walker and helps with balance.

• Gentle Stretching and Range of Motion - Targeted movements like calf stretches and seated toe curls, these are awesome for relief from the tension and cramping. These calf and toe curls have been, by far,  the most effective for me!

 I’ve turned to a range of tools to manage my pain. One of the most surprising breakthroughs for me has been these ice boots. I just keep them in the freezer and slip them on my feet for about 15 minutes. The cold therapy combined with gentle compression is a game-changer. They’ve brought my pain down dramatically—from a 9 all the way to a 5! It’s been an incredible relief, and these ice boots have been  part of my daily routine.  This is my top pick for daily pain relief. You will definately want these ASAP. You can pick up a nice pair from Amazon. Check out the link in the photo.

Cost - $10 to $50

I  use these compression boots multiple times a day—sometimes just sitting in my favorite chair, letting them work. A friend with neuropathy recommended them, and honestly, I’m so glad I gave them a shot. They’re a total game-changer—on high-pain days, they give me a deep, rhythmic massage that really eases the swelling and dulls that intense pain. 

Often categorized as "athletic recovery" gear, these full-leg sleeves are  a powerhouse tool for neuropathy. They use a process called intermittent pneumatic compression to mimic the body’s natural muscle pump. The way they work is to reduce intense, deep-tissue pain by flushing out metabolic waste and stimulating significant blood flow through the entire leg and foot.

These are a "must-have" for high-pain days. The rhythmic squeezing provides a unique massage that not only dulls pain but can actually help reduce the swelling (edema) that often makes neuropathy symptoms worse. They offer a level of relief that standard socks or manual massagers simply can’t reach. They are particularly effective because they provide a "passive" treatment—you can sit in your favorite chair, zip them up, and let the machine do the work.

Cost: $75 to $300

DRG Stimulator

I was amazed that after  years, my neurologist had never mentioned this option. So, I went to a pain relief doctor, and right away, they brought up the DRG surgery. After just eight weeks, the trial and implant were done, and my pain dropped dramatically—from a 9 down to a 2. It’s been absolutely incredible. 

The DRG stimulation targets specific spinal nerves by placing leads near the dorsal root ganglion to modulate pain signals and prevent pain in lower extremities. It involves a trial phase first, takes a week and you wear the device  taped to your back. Assuming you get good pain felief ( 50% relief or more). This is followed by a permanent implant .  The surgery is  outpatient and it takes about 2 hours, when you walk out of the building you end up with mostly surgical site pain. Expect to be very limited and restricted by your doctor,  can't bend, reach,  or pick up anything heavier than a gallon of milk! Amazingly the success rate is about 81% of patients who have experienced at least 50% pain relief at three months;

Cost: in the U.S.: $45,000 to $78,000.

It seems like allot of money but after 8 weeks post op I had not used anything for pain relief except for a little capcacian cream. I would estimate my pain hovers around 2-3 most of the time!!! This is from my previouse normal of 8-9. It is life changing. 

Insurance may cover this surgery (It did for me) it was less than $10K after deductibles and copays. Also there are overseas options. I looked at Germany and it was approx. $14K and India where it costs $9 to $10K. Prior to my surgery the insurance carrier (Cigna) had not approved it, I kept moving forward and decided if it wasn't covered I would just deal with the collections people at the Hospital. I was desperate and when I saw the over 80% success rate I knew I would do whatever I needed to get it done.

TODAY - I have about 75% of my pain gone