If you are diabetic chances are that you have or will have peripheral neuropathy. 60-70% of persons with diabetes will have the condition, although not all will experience pain related to the condition. Peripheral neuropathy is a condition of nerve damage often caused by diabetes and high levels of blood sugar associated with diabetics.
What symptoms are associated with diabetic peripheral neuropathy?
Peripheral neuropathy is the most common symptom of diabetes and is characterized by pain, numbness, and tingling in the feet, legs, and hands. The nerve damage that causes peripheral neuropathy is not localized to the hands and feet but rather all over the body. These damaged nerves interrupt the nerve signals to and from the brain from the extremities like the hands and feet. Persons with the condition may also experience a loss of sensations such as feeling hot and cold.
A person with peripheral neuropathy, although they may feel a constant pain in their hands and feet, could sustain and injury such as a cut and not feel that pain. They could develop ulceration of the skin from ill fitting shoes and not realize it as they would not feel the pain. Persons with peripheral neuropathy that experience numbness and tingling in their hands and feet but do not experience daily pain will also not feel pain from injury to the extremities.
Because of this inability to feel injury it is important to check their hands and feet for injury regularly, as perhaps a daily routine when they put on their shoes and socks, this will minimize risk of infections and ulcerations from an injury.
How is peripheral neuropathy diagnosed?
Diagnosis is performed by testing touch sensitivity with a filament (like tickling your foot with a feather), nerve conductivity testing with electrical impulses (usually performed along with Electromyography (EMG) which is used to measure the amount of electrical discharge in your muscles). Other similar testing is done to determine nervee responses to vibration and temperature change.
What treatments are available for treating diabetic peripheral neuropathy?
While there is no cure for peripheral neuropathy treatment is available. The purpose of treatment is to manage the symptoms of pain, restoring function of hands and feet, and slowing the progression of the condition. Slowing the progress of the condition involves monitoring blood sugar levels to make sure they stay within certain parameters, managing your weight, managing your blood pressure, getting sufficient exercise to promote blood flow and nerve function, eating a healthy diet, and quitting smoking if you smoke.
Treatment of the condition can consist of anti-seizure medications like pregabalin (Lyrica), gabapentin (Gralise, Neurontin), and carbamazepine (Carbatrol, Tegretol). Antidepressants like nortriptyline, amitriptyline, imipramine (Tofranil), and (Pamelor), desipramine (Norpramin), and opioid analgesics like tramadol (Ultram), hydrocodone (Vicodin), oxycodone (percocet, oxycontin). Lidocaine patches are another method of pain relief; these are patches of the topical anesthetic lidocaine that are applied directly to the painful area.
Side-effects of these medications cumulatively include decreased appetite, dizziness, constipation, headaches, and addiction, although the lidocaine patches have no known side effects other than skin irritation.
But perhaps the most effective treatment for peripheral neuropathy is the peripheral nerve block. Peripheral nerve blocks are injections of local anesthetics, and often accompanied by corticosteroid medications, in specific locations meant to numb the nerve associated with the felt pain. These injections are very effective in relieving pain from diabetic peripheral neuropathy and provide relief for extended durations of time.
During the injection procedure the patient will be placed on an exam table in the position most appropriate to access the injection location. The area to be injected is first cleaned with a topical antiseptic and then numbed with topical anesthetic to ease the sensation of the insertion of the needle. Then, under fluoroscope guidance, a thin needle is inserted and contrast dye is injected to ensure the medications reach the intended nerve. When it is confirmed that the needle is properly placed the mixture of medications are then injected.
The patient will often experience immediate relief from the local anesthetic but it typically takes a day or two for the steroid to take effect. Side effects and risks are minimal and include slight bleeding or bruising at the injection site and infection of the injection site (although this is very rare if the injection site is kept clean).
Patients who receive the injections often experience pain relief for anywhere from several days to several weeks after the first injection and the duration usually increases after several procedures and the steroid medications have taken full effect.