Diabetic Peripheral Neuropathy

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Peripheral neuropathy is a disorder involving the peripheral nervous system (PNS), all the nerves that come from your spinal cord and innervate the rest of your body. Peripheral neuropathy can be caused by many conditions. Some of these are, vitamin deficiencies, alcoholism, autoimmune diseases, certain medications, from unknown causes, an, very commonly, from diabetes. When your peripheral nerves become damaged, they do not function properly, causing 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. 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.  .

Exercise, nutrition, and proper medication and treatment, all assist in controlling diabetes. However, when a person cannot control their blood sugar through diet, exercise, and medication, additional health issues can occur. Diabetes is a severe risk factor for cardiovascular disease, peripheral neuropathy, kidney disease, and retinopathy (eye disease).

Diagnosis:

Diabetic peripheral neuropathy can be difficult to diagnose. A thorough neurological and physical exam, as well as a thorough history are imperative. Certain lab tests may be ordered by your physician in order to rule out other potential causes of peripheral neuropathy, like Vitamin B12 deficiency. Nerve conduction studies and an electromyography (EMG) may, also, assist in the diagnosis. Often times, diabetic peripheral neuropathy is a diagnosis of exclusion.

Treatment Options:

Treating diabetic neuropathy can be as difficult as diagnosing it. The first line of treatment is to control blood sugar levels, which cause the neuropathy. After this, symptom relief can begin. Your physician may recommend several different things until you find what is most effective for you.
Pharmacologic Therapy:

Membrane stabilizing medications are typically used for painful neuropathies. These medications work to “calm down irritated nerves,” but they can have a high rate of side effects, and this limits their usage. 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. Only blood sugar control can accomplish this.

Pain relievers, such as NSAIDs and opiates may offer some pain relief, but there is a concern of overuse and dependence that may develop. Additionally, NSAIDs can have adverse effects on those with diabetic kidney disease.

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:

Patients with painful peripheral neuropathies can be successfully treated with Spinal Cord Stimulation (SCS). Spinal cord stimulation is thought of “a pacemaker for pain management” and can be a very effective long-term treatment for all manner of neuropathies and other difficult to treat pain syndromes. You can read more about SCS by going to the section titled: Spinal Cord Stimulation Implants.

Articles:

Diabetic Peripheral Neuropathy – PainDoctor.com

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