By Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D

Diabetic peripheral neuropathy is a disorder involving the peripheral nervous system (PNS). The central nervous system (CNS) includes your brain and spinal cord, and the PNS includes all of the nerves that come from your spinal cord and innervate the rest of your body. Peripheral neuropathy can be caused by many conditions including vitamin deficiencies, alcoholism, autoimmune diseases, certain medications, unknown causes, and diabetes. When your peripheral nerves become damaged, they do not function properly and can eventually produce symptoms such as pain, tingling, or numbness.

https://www.youtube.com/watch?v=qe6E1BJZTyM

Diabetes

Diabetes can be broken down into two main types: Type I: Insulin Dependent and Type II: Non-Insulin Dependent Diabetes Mellitus. Over time, Type II DM patients may require insulin but they are still labeled Type II. Type I is seen most commonly in children and is due to a possible immunological cause, whereas Type II is caused by an acquired insulin resistance. Type II DM is frequently seen in obese patients and results when their bodies become resistant to their own insulin (hormone that controls your blood sugar). Patients with Type II DM must be educated about the types of foods that affect their blood sugars. By eating well-balanced foods in the correct amounts, you may be able to maintain your blood sugar levels close to normal and reduce the risk of the many detrimental consequences of diabetes.

Exercise is also extremely important in patients with diabetes. When a person exercises, their muscles use sugar for energy. With strenuous exercise the body breaks down sugar for energy and blood sugar levels decrease. Exercise can also increase your sensitivity to insulin. The first line of treatment in patients with newly-diagnosed diabetes Type II is diet, exercise, and weight loss because this may prevent the need for pharmacologic medication. When a person cannot control their blood sugar through diet and exercise, then medications are required. Diabetes is a severe risk factor for cardiovascular disease, peripheral neuropathy, kidney disease, and retinopathy (affecting the eyes), so strict blood sugar control is crucial for preventing these and other diabetes-related complications.

Diabetic-Peripheral-Neuropathy-ExplainedDiabetic Peripheral Neuropathy – Pathology

Patients who do not have a tight glucose control eventually have complications associated with diabetes (Smith 2007). An excess amount of sugar in the blood injures the capillary walls (small blood vessels) that supply your nerves, especially in your hands and feet. This destruction can cause nerve damage that may manifest as pain, numbness, or tingling that usually begins in the toes and moves towards the head. Erectile dysfunction is also common in men with poorly controlled diabetes as these blood vessels are damaged, too. Another complication from the nerve damage produced by diabetes is a neuropathy involving the gastrointestinal system. Damage to these nerves can cause problems with nausea, vomiting, diarrhea, or constipation. Postural hypotension may also ensue due to a progression of your peripheral neuropathy.

Diabetic Peripheral Neuropathy – Diagnosis

Diabetic peripheral neuropathy can be difficult to diagnose. A thorough neurological and physical exam as well as a thorough history are pertinent. Certain lab tests may be ordered by your physician in order to rule out other potential causes of peripheral neuropathy, such as a vitamin B12 deficiency. Nerve conduction studies as well as an electromyography (EMG) may also help your physician make a diagnosis. Oftentimes, diabetic peripheral neuropathy is based on exclusion of other possibilities and a strong history that is suggestive of it.

Diabetic Peripheral Neuropathy – Treatment Options

Even more difficult than diagnosing diabetic peripheral neuropathy is treating it. The goal of treatment is to control the blood sugar level that is causing your neuropathy and provide symptom relief. There are no quick fixes for diabetic peripheral neuropathy so your physician may recommend several different things until you find which is most effective for you (Smith 2007).

Most importantly, maintaining normal blood sugar levels is the first line of treatment and prevention for diabetic peripheral neuropathy.

Pharmacologic Therapy

Diabetic-Peripheral-Neuropathy-MassageMembrane-stabilizing medications are typically the drug of choice used to treat painful neuropathies. These medications typically calm down irritated nerves, but can have a high rate of side effects that may limit their use. Some of the medications that are particularly effective at treating nerve pain include Cymbalta, Elavil, Lyrica, Tramadol, and Neurontin. These medications may relieve pain but do not help to prevent the progression of the disease.

Pain relievers, such as NSAIDs and opiates, may offer some pain relief, but there is a concern of overuse and dependence that may develop along with other side effects. Opioids are usually not the drug of choice when treating nerve pain.

Alternative Therapies

Some alternative therapies that are used to treat diabetic peripheral neuropathy include:

  • AcupunctureAcupuncture: Harvard Medical conducted a study that stated that traditional Chinese acupuncture improved nerve sensation in diabetic peripheral neuropathy (Ahn 2007). Another study involving acupuncture in the treatment of peripheral neuropathy showed 77% of patients noted significant improvement in their symptoms, and 21% noted that their symptoms cleared completely. The study concluded that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy (Abuaisha 1998).
  • Biofeedback: Studies on the psychological assessment and treatment of neuropathic pain conditions, including diabetic peripheral neuropathy, showed that cognitive-behavioral interventions will improve the quality of life in these patients (Haythornthwaite 2001).
  • Nutrient and vitamin supplements: Certain nutritional supplements have been implicated in helping to treat and prevent neuropathies. Working closely with a nutritionist or physician, you can come up with a diet or supplements that may benefit your neuropathy. Alpha-lipoic acid, acetyl-L-carnitine, benfotiamine, methylcobalamin, and topical capsaicin are among the well-researched alternative options for the treatment of peripheral neuropathy. Other potential therapies include vitamin E, glutathione, folate, pyridoxine, biotin, omega-3 and -6 fatty acids, L-arginine, L-glutamine, taurine, N-acetylcysteine, zinc, magnesium, chromium, and St. John’s wort (Head 2006).

Advanced Interventional Therapies

At Arizona Pain Specialists we have successfully treated patients with painful diabetic peripheral neuropathy with a modality called spinal cord stimulation (SCS). Spinal cord stimulation is often thought of as a pacemaker for pain management and can be a very effective long-term treatment modality for neuropathies and other difficult-to-treat pain syndromes.

If you are suffering from peripheral neuropathy that has been refractory to other treatments, contact Arizona Pain Specialists today to see if you can benefit from any of these effective therapies.

At Arizona Pain, our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

References

  1. Smith RG. J J Am Podiatr Med Assoc. 2007 Sep-Oct;97(5):394-401
  2. Ahn AC, Bennani T, Freeman R, Hamdy O, Kaptchuk TJ. Two styles of acupuncture for treating painful diabetic neuropathy–a pilot randomized
    control trial Acupunct Med. 2007 Jun;25(1-2):11-7.
  3. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study.
    Diabetes Res Clin Pract. 1998 Feb;39(2):115-21
  4. Haythornthwaite JA, Benrud-Larson LM. Psychological assessment and treatment of patients with neuropathic pain. Curr Pain Headache Rep. 2001 Apr;5(2):124-9.
  5. Head KA Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006 Dec;11(4):294-329