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Diabetic Peripheral Neuropathy
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 from diabetes. When your peripheral nerves become damaged, they do not function properly, and can
eventually produce symptoms such as pain, tingling, or numbness.
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 become insulin requiring but are still labeled Type II. Type I is seen most commonly in children and is due to a
possible immunological cause, whereas as 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.
Pathology:
Patients who do not have a tight glucose control eventually have the complications associated with diabetes (Smith 2007). An excess amount
of sugar in the blood injures of 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 usaually begins in the toes and move proximal
(towards to 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 and/or constipation. Postural hypotension may also ensue due to a progression
of your 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 Vitamin B12.
Nerve conduction studies as well as an electromyography (EMG) may also help your physician make your diagnosis. Often times, diabetic
peripheral neuropathy is based on exclusion of other possibilities and a strong history that is suggestive of it.
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,
including pharmacologic and no pharmacologic therapies (Smith 2007).
Most importantly, maintaining normal blood sugar levels is the first line of treatment and prevention for diabetic peripheral neuropathy.
Pharmacologic Therapy:
Membrane 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 which are particularly effective
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:
Acupuncture - Harvard medical conducted a study which 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 peripheral neuropathies 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. You can read more about SCS by going to the section titled:
Spinal Cord Stimulation Implants.
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.
Articles:
Smith RG. J J Am Podiatr Med Assoc. 2007 Sep-Oct;97(5):394-401
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.
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
Haythornthwaite JA, Benrud-Larson LM. Psychological assessment and treatment of patients with neuropathic pain. Curr Pain Headache
Rep. 2001 Apr;5(2):124-9.
Head KA Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006 Dec;11(4):294-329
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 from diabetes. When your peripheral nerves become damaged, they do not function properly, and can
eventually produce symptoms such as pain, tingling, or numbness.
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 become insulin requiring but are still labeled Type II. Type I is seen most commonly in children and is due to a
possible immunological cause, whereas as 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.
Pathology:
Patients who do not have a tight glucose control eventually have the complications associated with diabetes (Smith 2007). An excess amount
of sugar in the blood injures of 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 usaually begins in the toes and move proximal
(towards to 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 and/or constipation. Postural hypotension may also ensue due to a progression
of your 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 Vitamin B12.
Nerve conduction studies as well as an electromyography (EMG) may also help your physician make your diagnosis. Often times, diabetic
peripheral neuropathy is based on exclusion of other possibilities and a strong history that is suggestive of it.
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,
including pharmacologic and no pharmacologic therapies (Smith 2007).
Most importantly, maintaining normal blood sugar levels is the first line of treatment and prevention for diabetic peripheral neuropathy.
Pharmacologic Therapy:
Membrane 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 which are particularly effective
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:
Acupuncture - Harvard medical conducted a study which 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 peripheral neuropathies 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. You can read more about SCS by going to the section titled:
Spinal Cord Stimulation Implants.
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.
Articles:
Smith RG. J J Am Podiatr Med Assoc. 2007 Sep-Oct;97(5):394-401
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.
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
Haythornthwaite JA, Benrud-Larson LM. Psychological assessment and treatment of patients with neuropathic pain. Curr Pain Headache
Rep. 2001 Apr;5(2):124-9.
Head KA Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006 Dec;11(4):294-329
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| Diabetic Neuropathy Look for this Article Coming soon |
Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions