Diabetic nerve pain, also referred to as diabetic neuropathy, affects the body’s ability to feel pain. Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet. Up to 50 percent of people with diabetes may experience diabetic nerve pain. Nerve damage can affect the ability to sleep, decrease quality of life, and cause depression. Significant neuropathy can develop within the first ten years of being diagnosed with diabetes. The risk increases the longer the patient has diabetes.
Recent studies reported that 60 percent of patients have some sort of neuropathy, but in 30 to 40 percent there are no symptoms. Diabetic neuropathy also appears to be more common in smokers, individuals over the age of forty, and those who have problems controlling their blood sugar levels.
Diabetic neuropathy is a common and serious complication of diabetes. But you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.
What Is Diabetic Nerve Pain?
Diabetics can develop painful sensations in their feet or hands, also known as diabetic neuropathy. It is a common complication of diabetes and is caused by poorly managed blood sugar levels over a period of time. Diabetic nerve pain can take years to develop, but as it progresses the pain gets worse, often at night. It is still unknown how diabetes affect the nervous system, but further damage can be prevented by controlling blood sugar levels.
Nerve pain differs from the common muscle pain most people are familiar with. Muscle pain is caused by something specific, like an inflammation or an injury. The nerves in the injured area send signals to the brain that damaged happened and something caused harm. Muscle pain gets better over time, once the harmful activity is stopped; however, nerve pain happens when nerves send extra signals to the brain, but it causes pain when you do something that is not normally painful.
Types of Diabetic Neuropathy
There are two categories of diffuse neuropathy: peripheral and autonomic. Peripheral neuropathy affects the feet and hands. Autonomic neuropathy affects the internal organs.
Peripheral Neuropathy is the most common type of diabetic nerve pain, and affects the limbs, mostly the feet. Nerves on both sides of the body are affected.
Another form of diffuse neuropathy, autonomic neuropathy affects the nerves that serve the internal organs and produce changes in many processes and systems. In autonomic neuropathy, the heart, digestive system, sexual organs, urinary tract, and sweat glands can be affected.
Focal neuropathy can appear suddenly and affect specific nerves, often in the head, torso, or leg. It also causes muscle weakness or pain. This kind of neuropathy is unpredictable and mostly occurs in older patients with mild diabetes.
Symptoms of Diabetic Nerve Pain
Diabetic nerve pain is a sign that the nerves in a part of your body are damaged. Unfortunately, nerves can become damaged before any physical symptoms develop and the damage cannot be reversed. Diabetic nerve pain varies from patient to patient, but the pain can be described as shooting, burning, pins and needles, electric shock-like, throbbing, tingling, stinging, stabbing, radiating, sensitive to touch, and even numbness. Diabetic neuropathy can cause both pain and insensitivity to pain in the same patient.
The damage to nerves is often the results of loss of reflexes and muscle weakness. The foot often becomes wider and shorter, the gait can change, and ulcers develop on parts of the foot that are less protected when pressure is applied. If an infection develops to the point that it infects the bone, amputation is required. This major complication is caused by minor injuries that can be treated effectively, if they are caught in time. Daily foot examination can help prevent amputation.
This type of neuropathy most often affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from emptying completely causing bacteria build up in the urinary tract, further nerve damage can cause urinary incontinence. Although it appears the sex drive remains unchanged, nerve damage can result in a gradual loss of sexual response in both men and women.
Nerve damage to the stomach can cause it to empty slowly, resulting in a disorder known as gastric stasis. Severe symptoms include persistent nausea, vomiting, bloating, and loss of appetite. Blood glucose levels also tend to fluctuate greatly.
Nerve damage can also interfere in the cardiovascular system. Nerves within the cardiovascular system send out impulses when a part of the body needs blood. These impulses also regulate blood pressure and heart rate. Without these signals, blood pressure drops sharply after sitting or standing, causing a person to feel dizzy or light-headed.
Nerve damage caused by autonomic neuropathy also affects the body’s response to low blood sugar and sweat gland activity, making it difficult to regulate body temperature.
Focal neuropathy is painful and unpredictable, but can improve by itself after a period of weeks or months without long-term damage. Pain in the front of the thigh, severe lower back pain, pain in the chest, stomach or flank, inability for eyes to focus, double vision, bell’s palsy, and hearing problems are common in focal neuropathy.
In general, people with diabetes are also prone to developing compression neuropathies. The most common of which is carpal tunnel syndrome. Asymptomatic carpal tunnel syndrome occurs in 20 to 30 percent of people with diabetes, and symptomatic carpal tunnel syndrome occurs in 6 to 11 percent. Numbness and tingling of the hands are the most common symptoms.
Treatment of Diabetic Nerve Pain
Diabetic neuropathies cannot be reversed, but proper treatment can relieve the discomfort of diabetic nerve damage and prevent further tissue damage. The first step is to bring blood sugar under control by diet, insulin injections, oral drugs, and by carefully monitoring blood sugar levels. The connection is still unknown, but maintaining normal blood sugar levels helps prevent further nerve damage.
Using a low dose for a short time of an over-the-counter pain reliever, like Tylenol can help control your symptoms, but other options exist for stronger, longer-term relief.
Antidepressants are typically used to treat depression, but they can be used for diabetic nerve pain. These medications interfere with the chemicals in the brain that cause the feeling of pain. Tricyclic antidepressants, like Tofranil can cause unpleasant side effects like dry mouth, fatigue, and sweating. An alternative to these is serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta, which tend to have fewer side effects.
OxyContin and opioid-like medicine can treat intense pain, but they are typically a last resort. However, because of the side effects and potential for addiction, they are not intended for long-term use. Lidocaine patches can be placed on the skin to deliver pain relief with a local anesthetic.
Anti-seizure medications have shown that they can also help with diabetic nerve pain. These drugs include Lyrica, Gaborone, and Neurontin, to name a few.
Low-impact exercises, like swimming, are the most effective type of exercise for diabetic patients. High-impact activities cause further nerve damage and even cause the nerves to go numb. Proper attention to exercise by an expert can help prevent any further damage. Be sure to choose a physical therapist who understands neuropathy and diabetes.
When to See a Doctor
Early diagnosis and treatment of any health condition gives you the best chance for controlling your diabetes and preventing future problems. If you experience a cut or sore on your foot that won’t heal or is infected, weakness or pain in your hands or feet that interfere with daily activities, changes in digestion, urination or sexual function, or dizziness, let your healthcare professional know. These symptoms may not mean that you have nerve damage, but they can be a sign of another condition that requires medical attention.
Maintaining normal blood sugar levels can prevent further damage and is the best way to avoid diabetic nerve pain. Follow your doctor’s advice for proper diet, exercise, and treatment guidelines. While diabetic neuropathies do not have any known cures, there are treatments that can help lessen discomfort and diabetic nerve pain. Your doctor can assist you in selecting the right treatment for you.
Patients with diabetes need to take special care of their feet. Foot ulcers increase the risk of neuropathy and blood vessel disease. Feet are the most affected by nerve damage since they are the longest nerves in the body. Patients who experience loss of sensation in their feet need to pay extra attention to foot care, as ulcers may go undetected and become infected.
Wash your feet daily, using warm (not hot) water and a mild soap. If you have neuropathy, you should test the water temperature with your wrist before putting your feet in the water. Doctors do not advise soaking your feet for long periods, since you may lose protective calluses. Dry your feet carefully with a soft towel, especially between the toes.