Painful diabetic neuropathy is nerve damage that results from diabetes. The high blood sugar that frequently appears as a result of diabetes can cause permanent injury to nerves throughout your body, which causes the intense pain. PDN presents as a burning, excruciating, stabbing or intractable type of pain, or presents with tingling or numbness. Nerves in the legs and feet are most often damaged with this condition. The symptoms are often painful and debilitating. Diabetic neuropathy is a serious complication from diabetes and can affect up to 50% of people with diabetes.
As a result of the nerves affected, painful diabetic neuropathy can produce pain and numbness in your legs and feet and lead to issues with your digestive system, urinary tract, heart, and blood vessels.
The American Diabetes Association recommends that screening for diabetic neuropathy begin immediately after someone is diagnosed with type 2 diabetes, and five years after diagnosis for someone with type 1 diabetes. After that, screening is recommended annually.
There are four distinct types of diabetic neuropathy: peripheral neuropathy, autonomic neuropathy, proximal neuropathy (diabetic polyradiculopathy), and mononeuropathy (focal neuropathy). The exact cause of each type of neuropathy is unknown.
Researchers think that, over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
According to Mayo Clinic, since there are four main types of diabetic neuropathy, symptoms depend on the type of diabetic neuropathy someone has and its degree of severity. Symptoms typically have a gradual onset, and many don’t notice they have a problem until they have experienced considerable nerve damage.
This type of neuropathy may also be called distal symmetric peripheral neuropathy. It’s the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:
The autonomic nervous system controls your heart, bladder, stomach, intestines, sex organs and eyes. Diabetes can affect nerves in any of these areas, possibly causing:
This type of neuropathy — also called diabetic amyotrophy — often affects nerves in the thighs, hips, buttocks or legs. It can also affect the abdominal and chest area. Symptoms are usually on one side of the body, but may spread to the other side. You may have:
There are two types of mononeuropathy — cranial and peripheral. Mononeuropathy refers to damage to a specific nerve. Mononeuropathy may also lead to:
Since diabetic neuropathy doesn’t have a known cure, the goals of treatment are to slow the progression of the disease, relieve pain, and manage complications/restore function.
To Slow Disease Progression:
Prescription drugs represent another possible therapy for diabetes-related nerve pain. Potential options for pain relieving prescription medication are:
The American Diabetes Association recommends pregabalin (Lyrica) and Gabapentin (Gralise, Neurontin) as options. Side effects can include drowsiness, dizziness, and swelling.
Antidepressants can alleviate nerve pain, even if you aren’t depressed. Tricyclic antidepressants can help with mild to moderate nerve pain. Amitriptyline, desipramine (Norpramin) and imipramine (Tofranil) are all in this category of drug. Side effects can include dry mouth and drowsiness.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressant that may help with nerve pain and have fewer potential side effects. The American Diabetes Association recommends duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Possible side effects include nausea, sleepiness, dizziness, decreased appetite and constipation.
Physicians may combine an antidepressant drug with an anti-seizure drug. These drugs can also be used with pain-relieving medication, including acetaminophen (Tylenol) or ibuprofen (Advil or Motrin IB) or a skin patch with lidocaine (a numbing substance).
It’s the only spinal cord stimulation system approved by the FDA to manage pain associated with diabetic neuropathy.
The HFX™ Solution treatment system involves a minimally-invasive implant procedure, allowing the patient to go home the same day. The spinal cord stimulation device then delivers mild electrical pulses to the nerves, interrupting the transmission of pain signals to the brain, which reduces pain.
The treatment a patient requires will depend on the neuropathy-related complication a person has.
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