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

Capsaicin Cream

Capsaicin cream was a surprise find. My daughter told me about it. The cream is derived from chili peppers and it provides heat to help manage middle-grade pain and improve sensory feedback. This stuff is great because it's cheap and you can have tubes scattered around — in your car, office, or wherever you need them for quick relief. I keep it in the car for "emergency" use (like when I can't feel the pedals).

• The Cost: $3 to $6 / tube. I use about 3 tubes a month.

The Heavy-Duty Stuff: Compounded Prescription Cream

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

• The Cost: $80 to $120 copay / tube. Each one lasts me about 2 months. 

• Also I have  copay to see the doctor who prescribes it. 

Unless you are in the very small number of people that like to go to the gym, pretty much nobody wants to exercise. Despite that, some simple exercises do help in managing neuropathy pain. Through exercise you can improve circulation, flexibility, and maintain your strength.

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 that 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! Helps get a little relief.

If you interested in relief from the shoulder, neck, and lower back pain I recommend 100% that you find a nearby Planet Fitness. They have incredible massage equipment. These are in order of preference:

• Hydro Massager - awesome spa bed that you lay on and choose any area you want to massage. Pressurised water heated at about 100 degrees massages you through comfortable bed. AWESOME!

• Traditional massage chairs - These are the one that use mechanical rollers and compression cuffs on arms and legs. I love these chairs... after using one for a few weeks I got really good at adjusting the massage type and intensity settings, this saves losing 3 or 4 minutes after it starts.

The monthly cost for a black card membership is $25/mo with no contract. I generally go about 19 or 20 times a month because I get so much pain and stress reduction ( I also live about 5 minutes away). Over the past year I hoped to get interested in actually working out or running on a treadmill - not yet. I suspect I will start as soon as I figure out the supplements are working !

 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 works!. They’ bring my pain down dramatically—from a 9 all the way to a 5! It’s been an incredible relief that lasts 15-30 minutes and break the pain. 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.

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 score 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 several years, my neurologist had never mentioned this option. 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 relief ( 50% relief or more), it 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 without insurance

It seems like allot of money but after 8 weeks post op I had not used anything for pain relief except for a little capsaicin cream. I would estimate my pain hovers around 2-3 most of the time!!! This is from my previous 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! Life is good and the pain feels very manageable. You still have neuropathy but you can have a life.