Patients with diabetes can develop abnormalities of the peripheral nerves in their extremities over time. This condition is called diabetic neuropathy, and it causes abnormal sensations, numbness, and pain of the feet and lower extremities.
What symptoms are associated with diabetic neuropathy?
The symptoms typically develop 10-20 years after diabetes is diagnosed. The symptoms usually develop in stages. First, the patient will have intermittent pain and tingling of the extremities, especially the feet. In later stages of the disease, the pain is more constant and intense. In the last stage, all sensation is lost in the affected extremities, which increases the patient’s risk for tissue injury.
Symptoms are related to which nerves are affected. With mononeuropathy, symptoms are often related to the thoracic and cranial nerves, which cause pain and numbness of the chest wall or face. With autonomic neuropathy, the person will experience nausea, vomiting, constipation, diarrhea, incontinence, and sweating abnormalities.
Who has diabetic neuropathy?
In a population-based sample and cross-sectional study, researchers evaluated the prevalence of painful diabetic neuropathy. They found that around 30% of the diabetics had neuropathy, and of these, 80% reported moderate or severe pain. They concluded that having peripheral diabetic neuropathy had a significant negative effect on quality of life.
What causes diabetic neuropathy?
Increased blood glucose levels affect the vessels that take blood to and from the lower extremities. Over time, decreased blood flow affects the nerves, which degenerate. Nerve degradation causes the pain, tingling, and loss of sensation in the extremities.
What risk factors are associated with diabetic neuropathy?
Risk factors for diabetic neuropathy include:
- Having type 2 diabetes
- A genetic predisposition
- Having diabetes for more than 25 years
- High blood pressure
- Lack of exercise
- Peripheral artery disease
How is diabetic neuropathy diagnosed?
The Chicago pain doctor will first ask questions about your symptoms, take a medical history, and inquire about your glucose levels. After a detailed physical examination, tests are conducted.
Electrodiagnostic testing is a way to detect diabetic neuropathy. This involves nerve conduction studies (NCS), which exclude other abnormalities that have symptoms similar to diabetic neuropathy. In addition, skin biopsies are used to evaluate cutaneous nerve innervation, and muscle and nerve biopsies are used to assess for degeneration.
What medications are used to treat diabetic neuropathy?
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – Meloxicam and naproxen are examples of NSAIDS that reduce nerve irritation and inflammation. These drugs are useful to treat mild neuropathic pain.
- Tricyclic antidepressants – Because they change the way the brain perceives pain and regulate sleep, these medicines are useful for pain. Examples are nortriptyline and amitriptyline.
- Anticonvulsants – Certain medicines used for seizure control have been proven effective for pain management. Examples include pregabalin and gabapentin.
- Topical agents – Capsaicin and trolamine salicylate are topical creams that block pain sensations.
- Opioids – Also called narcotic analgesics, these drugs work by blocking pain signals. They can be delivered via topical patch, pill form, or injectable.
What interventional pain management techniques are used for diabetic neuropathy?
Treatment is aimed at stopping nerve and blood vessel degeneration and eliminating pain. Treatment options at the best Chicago pain centers include:
- Celiac plexus block – When diabetic neuropathy affects the nerves that supply the abdomen (the celiac plexus), a long-acting anesthetic can be injected onto the nerves, blocking pain signal transmission. This procedure is done using x-ray guidance to assure correct needle placement. In a recent review of meta-analyses, this procedure was found to have a 90% efficacy rate, with pain relief lasting for 3 months.
- Lumbar sympathetic block – When pain affects the lower extremities, the doctor can inject the nerves of the lower back with an anesthetic and/or neurolytic agent. In a randomized, double-blind, controlled trial conducted to determine effectiveness of this block, researchers found that participants had 50% or more functional improvement and pain relief. The success rate was 85% for the group.
- Intrathecal pump implant – For severe, constant pain, a small device can be implanted into the lower abdomen. This pump attaches to a catheter that delivers medication into the space surrounding the spinal cord.
Davies M, Brophy S, Williams R, & Taylor A (2006). The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care, 29(7), 1518-1522. doi: 10.2337/dc05-2228
Kaufman M, Singh G, Das S, et al. (2010). Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol, 44:127–134.
McGreevy K, Hurley RW, Erdek MA, et al. (2013). The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract, 13:89–95.
Manchikanti L, Singh V, Falco FJE, et al. (2010). Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: A randomized, double-blind, controlled trial with a 2-Year follow-up. Int J Med Sci, 7(3), 124-135.