Diabetic nerve damage to the feet, sometimes called diabetic
neuropathy,
or more correctly,
diabetic distal symmetric sensory polyneuropathy, frequently causes people with
diabetes to lose sensation in their feet, which is usually describe as "numbness."
There's really not much available to help this loss of sensation.
However, diabetic neuropathy occasionally creates a severe burning pain, or
other very unpleasant sensations, that are extremely frustrating. The following
treatment program is suggested for painful diabetic neuropathy.
First of all . . .
Get your diabetes straightened out as best you can! Aim to keep your
blood sugar tests normal as often as possible, and to get your glycosylated
hemoglobin value into the normal range. The blood sugar should ideally
be about 100 before meals, and 140 or 150 as the highest blood sugar
that is ever seen. This extremely tight control may require shots of insulin
several times daily, very careful attention to meal planning and frequent
monitoring of your blood sugar level, under the care of a knowledgeable
physician specializing in diabetes, working together with a nurse who is a
Certified Diabetes Educator. This seems to be the best
way to help to treat the painful feet.
Protecting your feet
Whether or not you have diabetic neuropathy, there is a list of
things to do to protect your feet
- Be careful to protect your feet from injury. Any minor injury may allow infection to set in, which could lead to gangrene and amputation. This means wearing shoes
at all times.
- Look at your feet (with your eyes, or someone else can look if it's difficult for you to do): every day! If new problems are seen, such as a blister or red spot, telephone your doctor's office promptly for advice; stay off your feet until you get other advice.
- Break in new shoes slowly, so that they don't accidentally cause blisters.
- Keep several pairs of shoes at work, or in the car, so you can rotate among them if your feet feel tired.
- Every patient with neuropathy resulting in anesthesia should be under the care of a podiatrist for routine foot care, such as trimming nails and calluses.
(In the U.S., Medicare will pay for this care every 60 days, if you have diabetes and are covered by Medicare health insurance.)
- And be sure the diagnosis is correct! (There are several other conditions that can also cause neuropathy). You should have an EMG/NCV study done, and some blood tests. Ask your diabetes specialist or neurologist if your personal physician isn't sure what to do.
What about pain medications?
Pain control with standard pain-relief medications such as aspirin,
ibuprofen, and acetaminophen may be helpful in some cases. You should be on a
regularly scheduled program of one of these, taking the medication several times
every day. Since these medications do have side effects, discuss which one to
use with your personal physician.
Unfortunately, these medications probably will not provide adequate relief,
and some patients have had narcotics prescribed for pain relief. We do
not recommend the use of narcotics to treat diabetic neuropathy under any
circumstances: diabetes control and "pain-blockers" can often
control the pain.
"Pain-blockers"
Medications that block pain can be very useful in the treatment of
diabetic neuropathy. These medications are not pain killers.
They were originally developed for the treatment of other conditions, and have
been found to work occasionally to relieve diabetic neuropathy.
It will be
necessary to try a medication program with one of these "pain-blockers"
for several months to find out if it might be helpful for your pain. Needless to
say, these medications have a risk of side-effects, which should be discussed
thoroughly with your physician before starting a trial. There is no guarantee
that any of the "pain-blockers" will work, and they must be tried, and
then decide whether it helped enough to keep it going, or whether a second (or
third) program might be tried.
Pain-blocking medications include:
- antidepressant medications, such as Elavil (amitriptyline), Prozac (fluoxetine), and others;
- anti-seizure medications, such as Dilantin (phenytoin), Tegretol (carbamazepine), and Neurontin (gabapentin).
New medications
New medications that treat
diabetic peripheral neuropathic pain
have been approved recently:
- Cymbalta (duloxetine hydrochloride)
was approved for use in the US in September 2004, and under review in the EU.
It is indicated in the United States for the treatment of major depression and the management of diabetic peripheral neuropathic pain. The European Commission has also approved duloxetine for the treatment of major depression and moderate-to-severe stress urinary incontinence in adults. As duloxetine has not been studied in children, the manufacturer (Eli Lilly) discourages its use in those under 18.
Its website is at
www.Cymbalta.com.
- Lyrica (pregabalin)
was approved for use in the US in December 2004
for the management
of neuropathic pain associated with diabetic peripheral
neuropathy and postherpetic neuralgia.
Its website is at
www.Lyrica.com.
Skin Creams
A non-prescription pepper cream for application onto painful skin is available. This medication has been shown to give relief for
painful diabetic neuropathy in some cases. It does have side effects of a transient
severe burning for a week or so, and it is
expensive.
Also see
Complications: Neuropathy
(this is a listing of webpages about neuropathy
at the
DiabetesMonitor)
Diabetic Neuropathy
at the
DiabetesMonitor
Medical Monofilament
"The Mission of Medical Monofilament Manufacturing is to produce the best possible, most affordable, individually calibrated sensory testing monofilament. Our objective is to “Partner in Prevention” by consistently providing an excellent product and service to our customers so they in turn may better educate and empower individuals with diabetes and contribute to lower extremity amputation prevention."
FDA approves drug for neuropathic pain associated with diabetes
|
|
|
