FAQ’s on Diabetic and Peripheral Neuropathy Treatment in Las Vegas

 

The main cause of neuropathy is diabetes mellitus. Diabetic neuropathy is a painful disorder that results in leg pain due to nerve damage.

Is diabetic neuropathy a common condition?

Diabetic neuropathy affects approximately 5-10% of all people who have had diabetes mellitus for five years or more. After 20 years, the number increases to 15%. Diabetes mellitus is a common metabolic condition that affects millions of Americans.

Who is at risk for developing diabetic neuropathy?

Not all diabetics have neuropathy. When blood sugar control is maintained, the disease does not develop. However, risk factors include:

  • Having diabetes for several years
  • Having type 1 diabetes
  • Hypertension
  • Male gender

What is the cause of diabetic neuropathy?

Based on current theory, excessive circulating blood glucose affects the nerves of the extremities. With accumulation of glucose and sorbitol, the polyol pathway is activated, causing nerve damage. Additionally, increased glucose levels leads to vascular resistance and interference with blood flow to the lower extremity nerves.

What are the different kinds of neuropathy?

There are three main types of neuropathy:

  • Peripheral neuropathy – This is the most common type, and it affects the lower extremity nerves of the body. The peripheral nervous system involves nerves that transport sensory signals from the spinal cord and brain.
  • Autonomic neuropathy – With damage to the autonomic nervous system nerves, certain body functions are affected. These nerves control digestion, sexual function, and circulation.
  • Focal neuropathy – Focal means only one nerve is affected, such as one that controls a muscle or an eye.

How does the doctor diagnose diabetic neuropathy?

If you experience nerve pain of the lower extremities, the doctor will suspect diabetic neuropathy. The doctor will take a medical history and conduct a detailed physical examination. To confirm the diagnosis, nerve conduction studies are used to assess leg and arm nerve impulses. For evaluation of muscle response to nerve signals, an electromyography is often used. These tests are often done at the same time, and

How is diabetic neuropathy treated?

The treatment for neuropathic pain depends on the extent of the nerve damage, the severity of the condition, and which therapies have not proven effective. A combination of treatments may be used to relieve the pain and associated symptoms of diabetic neuropathy. The doctor will recommend tight glucose control and smoking cessation. Options include:

  • Medications – First-line treatment for nerve pain are anticonvulsants, such as gabapentin and pregabalin. Tricyclic antidepressants also are helpful, including despiramine and nortriptyline. For severe pain, the doctor may prescribe opioid analgesics.

 

  • Celiac plexus block – When neuropathy affects the nerves that supply the abdominal region, the doctor can perform a celiac plexus block. A small needle inserted through the back using x-ray guidance, and a long-acting anesthetic is instilled onto the nerves. According to recent clinical studies, this block is 85-90% effective for pain relief.

 

  • Lumbar sympathetic nerve block – Similar to the other block, the doctor inserts a small needle into the back near the sympathetic nerves of the lower (lumbar) spine. A recent research report showed that this was 77% effective for pain relief.

 

  • Transcutaneous electrical nerve stimulation (TENS) – To interfere with pain signals, this device is worn on the outside of the body. Small wires are attached to electrodes placed on the skin.

 

  • Spinal cord stimulation (SCS) – When the patient fails on other treatments, the pain specialist may recommend a spinal cord stimulator. The device is surgically implanted into the lower abdomen or buttock. Wires run and connect to tiny electrodes placed along the spinal cord. The unit emits pleasant electrical impulses that interfere with pain sensations. Based on a recent research report, SCS has a success rate of around 77%.

Resources

Possidente CJ & Tandan R (2009). A survey of treatment practices in diabetic peripheral neuropathy. Primary Care Diabetes, 3(4), 253-257.

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: http://dx.doi.org/10.1053/j.trap.2011.03.001