FAQs of Diabetic Neuropathy Treatment in Nashville & Murfreesboro TN

The Centers for Disease Control and Prevention (CDC) estimates that around 23.6 million people in the U.S. have diabetes, which is around 7% of the population. One painful complication of diabetes is diabetic neuropathy. Diabetic neuropathy is the most common type of neuropathy, occurring in approximately 50% of people with diabetes. Diabetic neuropathy puts patients at risk for developing skin ulcers that do not heal, resulting in loss of a toe, foot, or leg.

What causes diabetic neuropathy?

In diabetes, the nerves become damaged due to decreased blood flow and continuous high levels of blood sugar (glucose). Additionally, any injury or exposure to toxins can harm nerve tissue. Experts believe the nerve damage occurs from constricted blood vessels that impair the nerves, combined with the presence of excessive glucose. The damaged nerves lead to sensory impairment, where the patient has trouble sensing pain, leading to injury.

What are the symptoms of diabetic neuropathy?

The symptoms of diabetic neuropathy develop gradually over the course of several years. The symptoms depend on the nerves that are affected. The nerves of the legs and feet are most often damaged, and symptoms typically begin in the toes. Symptoms include:

  • Tingling
  • Burning
  • Deep aching pain
  • Numbness

What are the risk factors for diabetic neuropathy?

Anyone with diabetes is at risk for diabetes, but certain factors make you more susceptible to nerve damage. The risk factors include:

  • Poor blood sugar control – This is the main risk factor for every diabetic complication.
  • Kidney disease – Diabetes damages the kidneys, which contributes to nerve damage.
  • Length of time – Having diabetes for a long period of time increases the risk for neuropathy.
  • Smoking – This hardens and narrows the arteries, which reduces blood flow to the lower extremities and damages nerves.

How does the pain specialist treat neuropathic pain?

There are several treatment options for diabetic neuropathy, such as:

  • Medications – For mild pain, the pain specialist will prescribe Tylenol or nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. In addition, tricyclic antidepressants are used. Certain antiepileptic drugs (Neurontin and Lyrica) show success at relieving neuropathic pain by reducing pain signals sent from nerve cells to the brain.
  • Lumbar sympathetic nerve block – In one large literature review, researchers found that sympathetic nerve blocks were effective for neuropathic pain. The doctor inserts small needles into the lower back region under x-ray guidance. A long-acting anesthetic is instilled onto the nerves.
  • Celiac plexus block – This is done to relieve neuropathy that affects the abdominal region. The doctor uses x-ray guidance to position a small needle through the soft tissues of the back and near the celiac plexus nerves. An anesthetic agent is instilled onto the nerves to provide long-lasting pain relief. Clinical studies found this block to be effective around 90% of the time.
  • Spinal cord stimulation (SCS) – When other treatment modalities fail, a spinal cord stimulator can be implanted near the spinal cord. This device sends safe electrical currents to the spine. Overall, the success rate is approximately 80% for this device, according to clinical studies.

Resources

Centers for Disease Control and Prevention (2008). 2007 National Diabetes Fact Sheet. Atlanta, GA: U.S. Department of Health and Human Services, CDC.

Edwards JL, Vincent AM, Cheng HT, & Feldman EL (2008). Diabetic neuropathy: mechanisms to management. Pharmacol Ther, 120:1.

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 trial. 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.org/10.1053/j.trap.2011.03.001