Diabetes is a complex chronic condition that comes with a host of symptoms if not properly managed. One of the most complicated and challenging symptoms to treat is diabetic peripheral neuropathy. Also referred to a peripheral neuropathy or diabetic foot pain, this complicated condition requires thoughtful diagnosis and comprehensive treatment. What is peripheral neuropathy, and what does diabetic nerve pain feel like? Here’s what you need to know.
What is diabetic nerve pain, or diabetic neuropathy?
Neuropathy is an over-arching term that means nerve pain. There are four types of neuropathy, including:
- Peripheral neuropathy
- Autonomic neuropathy
- Radiculoplexus neuropathy
- Mononeuropathy
Peripheral neuropathy refers to nerve pain that is experienced on the periphery of your body, like the hands and feet. This area is enervated by the peripheral nervous system (instead of the central nervous system, which deals only with the brain and spinal cord).
There are many conditions that can result in nerve pain in the farthest reaches of the body, including:
- Vitamin deficiencies
- Alcoholism
- Autoimmune diseases
- Certain medications
The most common cause of peripheral neuropathy, though, is poorly controlled diabetes.
The hallmark of diabetes is a nearly constant fluctuation of the blood sugar, with spiky highs and cavernous lows. This constant fluctuation damages the capillary walls (small blood vessels) responsible for delivering blood to the nerves, especially in the hands and feet. As the capillaries become more damaged, diabetic neuropathy symptoms begin to appear.
What does diabetic nerve pain feel like?
So what does diabetic nerve pain feel like? There are many symptoms, including early onset symptoms that may be mild and challenging to diagnose. Diabetic neuropathy symptoms usually begin in the toes and work their way towards the head.
The first symptoms you may experience are tingling and numbness in the toes or fingers. This may resemble the feeling of “pins and needles” when a foot that has fallen asleep begins to wake up. You may also experience cramping in the feet, poor reflexes, and poor balance or coordination. Some people experience hypersensitivity and feel painful sensations with the slightest touch (even of the bedsheet grazing your toes at night).
In one of the few visual symptoms of diabetic peripheral neuropathy, a person may develop what is known as a hammertoe. This foot deformity causes the toes to begin to curl under and develops as a result of unconscious modification of the gait due to pain or other symptoms.
As the condition progresses, symptoms become more pronounced and more challenging to treat.
11 common diabetic neuropathy symptoms
Left untreated, diabetic neuropathy symptoms increase in intensity as the condition worsens. Wondering what does diabetic nerve pain feel like? Here are 11 symptoms to watch out for.
1. Increased numbness
This feeling can worsen to the point where a patient is unable to feel their feet as they walk. This becomes especially dangerous when feet lose all feeling.
The patient is then unable to tell if their feet have been injured or if the bathwater they are about to step into is too hot. Serious scalds, burns, and cuts can result from this numbness.
2. Burning in the feet
Diabetic foot pain is often accompanied by tingling and burning in the feet.
Ranging in intensity from barely perceptible to full-blown unbearable, this is the nerves’ way of communicating distress even further.
3. Sharp, shooting pain
This is the type of pain that can leave a person breathless. Almost like an electrical shock, this pain can occur without any particular stimulus or prompt.
4. Increased pain at night
Whether it’s because you are no longer distracted by the concerns of the day or the hypersensitivity and pain caused by even the sheet touching your feet, diabetic nerve pain is often much worse at night, making sleep impossible.
Because poor sleep and increased pain are bidirectional, one makes the other more intense in a cycle that is hard to break.
5. Slow-healing wounds
An adequate blood supply is important for good circulation that helps heal wounds.
For patients with peripheral neuropathy, even the slightest wound may be slow to heal (or may not fully heal).
6. Muscle weakness
As peripheral neuropathy progresses, muscle weakness may develop.
The peripheral nervous system is not just responsible for sensory information. Signals for movement and coordination are also delivered via these nerves. Nerves that are damaged rely on inadequate or incomplete information to the muscles and may result in poor coordination and weakness.
7. Gastrointestinal issues
Most people don’t think about the gastrointestinal system when considering peripheral neuropathy, located as it is in the center of the body.
However, as peripheral neuropathy continues to progress, this system can also be affected. Nausea, vomiting, diarrhea, and constipation can all occur.
8. Sexual dysfunction
Men with peripheral neuropathy may experience erectile dysfunction related to decreased blood flow and poor nerve signaling.
Women may experience increased vaginal dryness and a lack of desire.
9. Urinary tract infections
Men and women both may experience urinary tract infections.
The body may be overwhelmed with infections elsewhere in the body, and other gastrointestinal issues can lead to issues in the urinary tract as well.
10. Postural hypotension
Also known as orthostatic hypotension, this condition occurs when a person’s blood pressure drops dramatically, even when sitting, causing them to faint.
This can be potentially serious if it occurs while driving or even when simply standing up.
11. Amputation
Diabetes is responsible for approximately 70,000 amputations of the lower limbs annually in the U.S.
When feeling leaves the lower extremities and wounds or sores go undetected, they can become infected and even gangrenous. In these cases, amputation must be performed to prevent further damage or even death.
Can diabetic neuropathy go away?
Without treatment, diabetic neuropathy will not resolve itself and can, in extreme cases, lead to death from infection. It is crucial to get a proper diagnosis first and then proceed with treatment.
In the beginning stages of diagnosis, your doctor will conduct bloodwork and lab tests to rule out other potential causes of your symptoms.
Once your doctor eliminates other conditions, they may perform additional tests, including:
- Nerve conduction studies: Measures nerve response to electrical stimulation
- Electromyography (EMG): Measures electrical discharge from the nerves
- Filament tests: Looks for hypersensitivity that is the hallmark of peripheral neuropathy
- Quantitative sensory testing: Measures the nerve response to sensory changes including vibration and temperature
How to treat diabetic peripheral neuropathy
Once you have a diagnosis, there are many treatment options to ease symptoms and prevent worsening of nerve pain.
1. Manage diabetes
Since diabetic nerve pain is caused by poorly managed diabetes that causes damage to the blood vessels, the first thing to do is to get your blood sugar under control.
Talk to your doctor about changes to diet, exercise, and insulin administration that can help.
2. Keep an eye on your feet
Early warning signs occur most often in the feet. Check your feet daily for blisters, cracks, ingrown toenails, or wounds that are slow-healing or getting worse.
The American Diabetes Association recommends an annual foot exam, but daily foot checks are crucial for early detection and treatment. If you are unable to bend down to see the soles of your feet, use a mirror or ask a family member to help.
3. Practice proper foot care
In addition to daily checks, taking care of your feet can help improve health.
Daily foot massage improves circulation and feels relaxing at the end of a long day. Keep feet clean, dry, and moisturized to maintain skin health, too.
4. Stop smoking and limit or avoid consumption of alcohol
Health begins with what you put in your body. Tobacco products in any form inhibit the body’s healing response and narrow already challenged blood vessels. Alcohol has a similar effect on the immune system, dampening the body’s response to infection.
Some people are able to consume a daily glass of red wine or two, but talk to your doctor. In acute stages of infection, avoid alcohol.
5. Get active
The prime risk factor for both Type 1 and Type 2 diabetes is obesity. Extra weight places a huge burden on your joints and feet, which can make self-care challenging.
To combat this, exercise maintains a healthy weight, slows nerve damage, and naturally manages blood sugar, all of which can help alleviate symptoms of peripheral neuropathy.
6. Investigate medication
There are some medications that can assist in pain relief. Anticonvulsant drugs and tricyclic antidepressants, although not well understood in how they work on this condition, do seem to help relieve diabetic foot pain by changing the way the brain senses pain.
Tricyclic antidepressants include:
- Amitriptyline
- Clomipramine (Anafril)
- Desipramine (Norpramine)
- Doxepin
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
Finding the right medication may take some time, so be patient with this treatment approach.
Non-opioid pain relievers may also help for acute cases, but opioids are not generally recommended for peripheral neuropathy.
7. Use topical creams and supplements
Capsaicin is the compound found in spicy peppers that can provide topical pain relief.
Alpha-lipoic acid (ALA) is a supplement that may help lessen the advance of diabetic peripheral neuropathy.
8. Try physical therapy
Physical therapy exercises for diabetic peripheral neuropathy can help provide relief from tingling, burning, and pain in the feet. These exercises also improve muscle strength and physical coordination. They may also help with sexual dysfunction by improving blood flow and circulation.
For patients who have injured their feet by changing the way they walk, consciously or unconsciously, gait training is a type of physical therapy that helps people learn how to walk again. It is also used for people who have a prosthesis to help them walk properly so as not to transfer injury or pain to another part of the body (e.g., the hips).
Some physical therapy is combined with electrical nerve stimulation, which may help with stiffness in the feet and speed healing of ulcers or other wounds on the feet.
9. Manage other conditions
If you are experiencing gastrointestinal side effects including nausea, constipation, or diarrhea, managing these is important. Focusing on a supportive diet can help.
Similarly, it is important to treat urinary tract infections promptly, as increased nerve damage may result eventually in urine leakage.
For patients with sudden drops in blood pressure, compression stockings for the abdomen and legs can help, as can simply taking care when changing position.
10. Research advanced care
Other pain-relieving injections and therapies can help with more advanced cases, such as TENS unit therapy or nerve blocks.
This complex condition also remains the focus of much research and study. For example, a recent non-viral gene therapy study offered promising results in the dramatic pain relief of diabetic peripheral neuropathy with low doses of medication, well into a year after the treatments.
Diabetic peripheral neuropathy is a challenging condition that needs a comprehensive approach to treatment. If you are experiencing this side effect of diabetes or another pain condition, give Arizona Pain a call today. We can help.