FAQ’s on Diabetic and Peripheral Neuropathy
Diabetes mellitus is the main cause of neuropathy. Diabetic neuropathy is a painful condition that results in neuropathic leg pain.
How common is diabetic neuropathy?
Diabetic neuropathy (DN) affects around 4-10% of all persons who have diabetes for more than five years. That number increases to 15% of 20-year diabetics.
What are the risk factors for diabetic neuropathy?
Not all diabetics develop this type of neuropathy. However, risk factors include:
- Male gender
- Having type I diabetes
- Long duration of either type of diabetes
What causes diabetic neuropathy?
According to experts, excessive circulating glucose affects the nerves of the extremities. This occurs through activation of the polyol pathway and accumulation of fructose and sorbitol affects nerves. In addition, persistent elevated glucose causes increased vascular resistance and reduction of blood flow to nerves.
What are the types of neuropathy?
The most common neuropathy is peripheral neuropathy, which affects the longest nerves of the body. The peripheral nervous system is a network of nerves that carry signals from the brain to the spinal cord, as well as to the back and body. With autonomic neuropathy, there is damage to the nerves that control unconscious body functions. This affects circulation, sexual function, and digestion. Focal neuropathy involves a single nerve that controls one body region, such as an eye or muscle.
How is diabetic neuropathy diagnosed?
If your doctor suspects you have diabetic neuropathy, he or she will take a detailed history of symptoms and conduct a physical examination. Nerve conduction studies assess nerve impulses of the legs and arms, and electromyography is done to see how muscles move in response to nerve signals. Usually, these two tests are done at the same time and involve mild electric shocks through tiny needles or pads on the skin.
What is the treatment for diabetic neuropathy?
Treatment for diabetic neuropathy focuses on pain relief, tighter glucose control, smoking cessation, and regular exercise to build muscle strength and burn glucose. Options for treatment include:
- Medications – To relieve nerve pain, options include gabapentin, pregabalin, tricyclic antidepressants (nortriptyline and desipramine), duloxetine, and carbamazepine. For severe pain, the doctor may prescribe narcotic analgesics. Additionally, topical therapies used include lidocaine, capsaicin, and menthol.
- Lumbar sympathetic nerve block – The doctor will insert a small needle into the lower back using x-ray guidance and instill a long-acting anesthetic onto the nerves. According to a recent clinical study, 77% of people have pain relief with this block.
- Celiac plexus block – The celiac plexus is a bundle of nerves that supply the abdominal region. With this block, the doctor inserts a needle near the nerves and injects an anesthetic agent. Research studies show this block to be 85-90% successful.
- Transcutaneous electrical nerve stimulation (TENS) – This device is worn on the outside of the body. Small wires attach to electrodes and run from the unit. The unit delivers mild electrical current to electrodes place along the back, which interfere with pain signal transmission.
- Spinal cord stimulation (SCS) – If the patient fails on all other treatment modalities, a spinal cord stimulator can be implanted into the lower abdomen. Wires run from the unit to the spinal cord, where tiny electrodes are surgically placed. This unit delivers pleasant sensations to the spinal cord and block pain. In a recent clinical study, SCS was found to have a 77% efficacy rate.
Possidente CJ, Tandan R. A survey of treatment practices in diabetic peripheral neuropathy. Prim Care Diabetes. Nov 2009;3(4):253-7.
Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am, 88(8):1722-1725.
Slangen, R, Schaper, NC, Faber, CG et al. (2014). Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: A prospective two-center randomized controlled tial. Diabetes Care. doi: 10.2337/dc14-0684
Vorenkamp, KE & Dahle, NA (2011). Diagnostic celiac plexus block and outcome with neurolysis. Pain Management, 15,(1), 28-32. DOI: http://dx.doi.org/10.1053/j.trap.2011.03.001
Zochodne DW. Diabetic polyneuropathy: an update. Curr Opin Neurol. Oct 2008;21(5):527-33.