Diabetes affects many Americans and many of our patients. Diabetics have multiple self-care items that they must be attentive to: they need to monitor their intake of carbohydrates, they need to maintain a healthy weight through a combination of diet and exercise, they need to monitor their blood glucose levels and they need to be compliant about taking their medication, whether that medication is insulin or other medications that help the body to process glucose.
Diabetes also brings with it other health complications, including a higher risk for cardiovascular disease.
Perhaps less well known, however is the number of diabetic patients who suffer from pain issues that are a result of their diabetes.
Diabetes causes a specific form of nerve damage which is called diabetic neuropathy, which can trigger these types of chronic pain:
- Peripheral neuropathy: pain and/or the loss of feeling in the extremities (toes, feet, legs, hands and arms).
- Proximal neuropathy: pain in the thighs, hips and buttocks, which can contribute to weakness in the legs, causing instability and balance issues.
- Focal neuropathy: the sudden weakness of either one single nerve or a complete group of nerves, which can then turn into localized muscle weakness or pain. This can occur in a variety of places, behind one eye, in the neck, back, chest, inside the foot, etc.
- Foot injuries and issues: special care has to be paid to the feet which can often be injured without the diabetic patient feeling the injury due to numbness in that area. When there are injuries to the feet that are left untreated, further complications and mobility issues may quickly arise.
Treatment of Diabetic Neuropathy
The most important step in developing a treatment plan is a consultation with pain specialists. It is important to diagnose correctly the root of pain, to be certain it truly is diabetic neuropathy and not a different injury or disease process. A correct diagnosis will lead the treatment team down the path of appropriate treatment and care.
Diabetic neuropathy isn’t necessarily curable; it is a chronic disease, just like diabetes itself. Your health care team will partner with you to manage your diabetic neuropathy. In general, keeping your blood glucose level at your targeted range is the best thing you can do to keep your diabetic neuropathy at bay. If your diet and exercise need monitoring or tweaking, you may need the help of nutritionists, physical therapists and diabetic educators.
Certain over the counter drugs often provide relief, including aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs like ibuprofen or a topical cream such as capsaicin. If you have been diagnosed with diabetic nephropathy (where there is kidney involvement, too), then you can only use anti-inflammatory drugs under a physician’s supervision.
Severe pain may require stronger prescription medication, either pain-reducing medicine, or medications that treat for depression and even seizure disorders (even if you do not suffer from depression or seizure disorders).
Other therapies may also provide a measure of relief including relaxation training and meditation, gentle massage, biofeedback, acupuncture and the use of transcutaneous electronic nerve stimulation (also known as TENS). Mild exercises that are tolerable, like light swimming, gentle stretching and leisurely walking may also prove to be effective not only in reducing pain but also in management of blood glucose levels.