Diabetic peripheral neuropathy or DPN affects as many as 50% of diabetic individuals, and it is predicted approximately a million patients in the United States suffer from DPN. It develops after prolonged diabetic damage to the peripheral nerves such as in the hand, arms, legs and feet.
Diabetic peripheral neuropathy can be incapacitating and have a negative impact on the patient's life quality as well as affect daily functions of life.
While there is no current cure of diabetic peripheral neuropathy, treatment is available with goals to manage symptoms, restore function, relieve discomfort , and prevent further progression. Oral medications are the first line treatment for diabetic peripheral neuropathy suchs as gabapentinoids (gabapentin, pregabalin) and antidepressants such as duloxetine and nortriptyline. These treatments, however, are not uniformly efficacious or well tolerated. The FDA has recently approved several spinal cord stimulation devices as an effective therapy to overcome diabetic peripheral neuropathy pain.
Diabetic peripheral neuropathy is a condition where there are damaged nerves in the peripheral nervous system of the body. Uncontrolled high glucose in your blood binds to certain cells throughout your body and causes damage over a long period of time. This is especially true with nerves. Peripheral means your limbs, so your arms, hands, legs, and feet. Patients with diabetes over a long period of time are at risk of getting peripheral neuropathy. Over a long period of this nerve damage and inflammation, the motor and sensory communication between the brain and the innervated area of the body are compromised. Symptoms of the condition worsen over time if diabetes is left untreated. Peripheral neuropathy may also worsen with chemotherapy treatment or radiation therapy.
Types and severity of symptoms can vary person to person in what is experienced. Symptoms often start with the feet and legs and then develop in the hands and arms later. Symptoms may also be worse in the evenings compared to morning and during sedentary periods. Symptoms may worsen over time as the nerves get more damaged. Some of the common symptoms include:
One of the main goals of treatment is to prevent further or slow neuropathy development. This can be done via lifestyle changes such as diet and moderate exercise. Medications such as insulin or metformin or other medications can be prescribed to aid in tight blood glucose control. Monitoring of after meals and after medication blood sugar levels can help guide getting to targets. There are also continuous blood glucose monitors that can let you check blood sugar at any time. The goal with continuous blood glucose is to increase Time in Range or (TIR), that is the percentage of time that your blood glucose is in the target range. The tighter control of blood glucose range, the less damage can occur. Regular blood work to check HbA1C is also necessary to see how controlled the blood glucose was over the last few months.
The other main treatment goals include reducing discomfort and regaining function. Oral medications that are used include anti-seizure drugs such as pregabalin, or gabapentin, and antidepressants such as tricyclic antidepressants or serotonin and norepinephrine reuptake inhibitors ( SNRIs). There are also skin patches or topical creams with lidocaine or capsaicin that may help symptoms. Capsaicin is a compound found in peppers that can reduce pain sensation. These drugs can be used to relieve pain and dull symptoms. Spinal cord stimulators are another modality of treatment symptom management.
Spinal cord stimulator (SCS) or peripheral neurostimulator is an implanted medical device. The device is connected to electrodes implanted next to your spinal. These electrodes send electric pulses down the spinal cord to interrupt nerve transmission of the pain. The device can be customized to your pain control needed and can be turned off if needed. Spinal cord stimulator is used for many chronic pain conditions.
The spinal cord stimulation will block the pain and discomfort signals going to the brain. According to research, spinal cord stimulators are an effective therapy for neuropathic pain and significantly improved the quality of life for those with painful diabetic neuropathy. In a meta-analysis, spinal cord stimulation used as an adjunct, patients had significantly better relief than just with medications alone.
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