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The Pain of Diabetic Neuropathy
Dr Ramesh Goyal
Loss of sensation in the lower limbs and feet contributes to the risk of developing foot ulcers. It is thus important that persons with diabetes wear properly fitting shoes and regularly examine their own feet for sores or other skin changes.  

What is Diabetic Neuropathy?
  • Neuropathy, in common English, means nerve disease.
  • Diabetic neuropathy affects peripheral nerves - those outside of the brain and the spinal cord, such as nerves in the arms, legs, hands, and feet.
  • Some elderly diabetics with neuropathy also develop a condition called diabetic myopathy (muscle wasting), in which the small muscles of the foot, as well as some other muscles, become thinner and weaker.
Will it really pain?
  • Pain will usually affect the arms, legs, hands, and feet.
  • You’ll also have pain in the nerves of both legs or partial or complete loss of feeling, particularly in lower limbs. The pain is often worse in bed at night. A less common type involves weakness, severe pain, and muscle wasting.
  • Neuropathic pain can feel like burning, prickling, tingling, aching, stabbing, pins and needles, shooting, and even like an electrical current "buzz."
  • The most common type of neuropathic pain occurs on both sides of the body, as in both legs and feet, or both hands.
  • Neuropathic pain can come and go or it can continue for a long time.

Is that all?
  • Neuropathic arthropathy or charcot joint can also result, where the joints are deprived of pain and position sense due to the neuropathy – making them more susceptible to injury. The joints in the foot are also severely damaged.
  • Neuropathy can also affect other areas of the body, such as the digestive system and urinary bladder.
  • Autonomic neuropathy can cause low blood pressure when getting out of bed or rising from a chair (called orthostatic hypotension), diarrhoea, urinary retention (difficulty emptying the bladder completely), impotence (erectile dysfunction), and the pupils of the eyes may become smaller and react slowly to light.
Can this be prevented?
  • In some cases, diabetic neuropathy can be prevented. Patients who follow their recommended self-care program are less likely to develop diabetic neuropathy.
  • Tight control of blood sugar (keeping as near to normal levels as possible), following your diet and exercise plan, not smoking, and maintaining normal weight are all very important in preventing diabetic neuropathy.
  • Regular, frequent visits to your health care provider are also important.

Can I have some medicines?
  • So far, there is no "cure" for neuropathic pain. However, patients with neuropathic pain or autonomic problems can be treated.
  • Pain medications can help, especially if taken at regular times throughout the day. Waiting until the pain becomes severe before taking medication is not as effective as taking regularly scheduled doses.
  • Depending on the type and level of pain, your doctor might recommend an over-the-counter pain medication or a prescription drug.
  • Certain anticonvulsant drugs can help relieve persistent neuropathic pain.
  • Other medicines known to help relieve some kinds of persistent pain include antidepressant medications and local anaesthetics.
  • Capsaicin creams that can be applied to the skin are also effective in treating some neuropathic pain.
  • The most important steps in avoiding neuropathic pain are to maintain your ideal weight, exercise, control your blood sugar levels, and not smoke.

Dr Ambrish Mithal is Senior Consultant Endocrinologist, Indraprastha Apollo Hospitals, New Delhi
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