Pain due to a condition known as Diabetic Peripheral Neuropathy (DPN) is the cause of much frustration and anxiety to thousands of patients with diabetes.  For the most part this pain is described as chronic and defined as pain that persists for more than six months.  The pain is present almost daily and can interfere with many “normal” daily activities.  The exact cause of this pain is not well understood; but one thing has been shown for certain, blood sugar control is the one key element that affects the course of this condition.  National studies have proven that getting your A1C in better control by even a point can cause a significant improvement in diabetic neuropathy.  It is for this reason that one of the first steps in controlling the pain of neuropathy is controlling blood sugars.  It is not only important to keep your A1C below 7, but it is shown that extreme fluctuations in blood sugars, such as going very high to very low can also make neuropathy more likely to evolve.

Neuropathy, by definition, means diseased nerves.  Nerves become damaged and they sometimes lose the ability to sustain feeling, causing numbness, or they get hyper stimulated, causing pain.  The pain form DPN is often described as tingling, burning, sharp shooting pain, prickling or crawling sensations.  Neuropathic pain typically worsens at night, and the symptoms most commonly occur in the feet and lower limbs.  Sometimes neuropathy can occur with no obvious symptoms.  If there is numbness in the feet a person may be unaware until a foot injury occurs.  Therefore, annual foot exams are so important in patients with diabetes.

The treatment of DPN is multifaceted and very patient specific.  It depends on the level of pain and how often a patient has pain.  Some people only experience pain occasionally, while others deal with painful symptoms daily, which is referred to as chronic pain.  For patients with chronic pain, a prescription medication is generally prescribed.  There are several medications used for neuropathy; some of the more common ones are gabapentin, pregabalin, and amitriptyline.  These medications work by helping “calm” the nerve fibers, thereby helping stop the pain.  They can be quite effective, but can cause drowsiness and dry mouth as well, and are not tolerated by everyone.  There are also topical over the counter remedies for nerve pain such as Capsaicin.    Capsaicin may cause burning at first but can be effective.  There are also other remedies too numerous to mention; even vitamins are touted to help prevent and treat neuropathy; specifically, the B complex.

For those patients that cannot tolerate oral medications, biofeedback and meditation have been effective as well.  Exercise, as instructed by a trained professional can also be helpful in treating neuropathic pain.  Electrical stimulation can sometimes block pain signals that are emitted from damaged nerves.  The most used system is called TENS, which stands for transcutaneous electrical nerve stimulation.  The thought is that the stimulating pulses help prevent pain signals from reaching the brain.   Knowing that there are many ways to treat pain from DPN, a patient should not get frustrated if one method is not successful.

Remember that a diagnosis of DPN requires a trained professional, and other problems such as circulatory issues can cause symptoms like those involved with neuropathy.  If you have leg pain when you walk, and your legs appear discolored, swollen, and warm to the touch, you may have a circulatory problem unrelated to neuropathy.  This is also treated differently, so it is very important to get a proper diagnosis from a trained professional.

Don’t forget that at TempraMed we are here to protect you and your insulin from damaging temperatures and to keep you safe.