Relieving Pain in Patients with Diabetic Peripheral Neuropathy

Given the limitations of pharmacotherapy options for treating painful diabetic peripheral neuropathy, practitioners are also considering the merits of cognitive therapy, orthotic management, and combination therapies to relieve patients’ pain.

Peripheral Neuropathy: Treatment is Like Finding a Needle in a Haystack

Do you know that feeling when your leg falls asleep?  Some people refer to this as pins and needles or burning.  If you suffer from peripheral neuropathy then you know this feeling all too well.  Imagine the end of the day thinking you finally get to relax and forget all about the stresses of work, kids, the economy, but when you begin to relax your feet or even your legs begin to burn or having that feeling like they are asleep.  Some people describe the feeling of bugs crawling on their legs.  Either way it is hard to relax with this going on.

“Neuropathy” means nerve damage.  My initial impression of how to treat peripheral neuropathy was rather simple.  Something injured the nerve, find it, fix it, and the nerve gets better, right?  Wrong!  Nerves are tricky, very complex, yet very sensitive to injury.  Some of the more common nerve injuries that are linked to peripheral neuropathy include compression such as a bulging disc in your low back or carpal tunnel syndrome in your wrist, infections such as HIV or hepatitis, organ failure such as kidney or liver disease, poor blood flow, diseases such as Diabetes or autoimmune conditions, many medicines and drugs especially alcohol, and even poor nutrition causing vitamin deficiencies.  Put it this way:  there are about 150 known causes of neuropathy, which means there are at least another 150 causes we have yet to discover.

Finding the cause is like looking for a needle in a haystack.  There are so many potential causes and they can overlap.  A patient can have Diabetes, low thyroid, and degenerative disc disease in their low back, all of which can cause nerve damage.  Which one are you going to blame for that burning, tingling, and numbness in your feet?  Well, we try to blame it on the cause that is treatable.  This patient in my example can control their Diabetes, take thyroid hormone supplement, and their back can be fixed.  What if the burning and tingling in their feet remains?  In that case we now call the nerve damage, “idiopathic neuropathy”.  Basically a big word that means we really have no idea what is causing this nerve damage.

The next option is to treat the symptoms of neuropathy and I’m sorry to say that pain medications (narcotics) do not work for neuropathy pain!  There are older treatments such as anti-depressants and newer derivatives such as Cymbalta.  We can use medications aimed at preventing seizures in low dose like Gabapentin or Pregabalin.  There are the often overlooked physical therapy treatments such as electrical stimulation, counter-irritants such as Capsaicin or Biofreeze.  The treatment grows like a pyramid with more specific and more complex treatments at the top.  Anything above what I have already mentioned would best be prescribed by a Neurologist.  That’s the nerve specialist.

So what’s the take home message about neuropathy?  See your doctor, don’t wait!  Since I am a podiatrist at Desert Foot Surgeons, I am often the first to see a patient about these nerve complaints.  The longer you wait, the more difficult it will be to fix.