Neuropathic pain in diabetic people

Neuropathic pain in diabetic people or diabetic neuropathies is series of nerve disorders caused due to diabetes. People suffering from diabetes after period of time develop damages in nerve all through their body. Some people face no symptoms even with nerve damage whereas others experience problems such as numbness, pain or tingling of legs, feet, arms, hands. Every organ in system like heart, sex organs, and digestive tract can get nerve problems.

Causes of diabetic neuropathies

  1.  The causes vary but the common cause is nerve damage that occurs due to exposure to high levels of blood glucose.
  2. Metabolic factors like prolonged diabetes, abnormal levels of blood fat, low insulin levels, high levels of blood glucose
  3. Neurovascular factors like blood vessel damage and blood vessels carry nutrients and oxygen to our nerves
  4. Autoimmune factors lead to inflammation in our nerves
  5. Mechanical injury to our nerves like carpal tunnel syndrome
  6. Lifestyle factors like alcohol use and smoking
  7. Inherited traits which increase the chances of nerve damage

Symptoms – Diabetic neuropathies

Symptoms solely depend on the nerves that are affected and type of neuropathy and other symptoms are

  • Indigestion, vomiting and nausea
  • Urinating problems
  • Faintness or dizziness due to low blood pressure after sitting or standing up
  • Wasting hand, feet muscles
  • Numbness, pain or tingling in finger, arms, legs feet and toes
  • Constipation or diarrhea

Diabetic neuropathy is basically nerve disorders cause due to the abnormalities that are linked to diabetes like high level of blood glucose. Treatments involve correcting the levels of blood glucose to normal range. Regulating the blood glucose levels can help prevent or starting of future problems. Foot care is considered as essential part of neuropathic pain treatment. People suffering from neuropathic pain having diabetes should take very good care of their feet on a daily basis and check for injuries. If the injuries are left untreated it can lead to infection and foot sores.

Treatment for neuropathic pain in diabetic patients also includes medications for pain relief and other medications depending on the severity of nerve damage. Smoking too increases problems of foot or amputation.

Exercise can also help a lot in showing improvements in neuropathic pain especially in diabetic people.  People having diabetes should consult their doctor before they start with any exercise and once decided; making exercise part of daily routine can be helpful.

Look for exercises with low impact as such exercises are easily tolerated by most diabetic people. Exercises like aerobics, swimming, yoga, are ideal options. These exercises can help improve relaxation skills.

Try to avoid exercises of high impact as such exercises can have adverse impact on neuropathic pain. Exercise can really help in nerve pain and doing it consistently is helpful. Start slowly and then increase the time to half an hour, at least five times in a week. The key is to start slowly and increase the time gradually and be consistent.

In case of neuropathic pain, diabetic people should focus on keeping their sugar levels in control and follow the diet recommended by their doctor.

Herbal Supplements can give you relief from Neuropathic pain

Neuropathic pain is really difficult to manage. In some cases where the pain occurs due to herniated disc can be easily resolved and also the pain can go off. But, in patients having chronic medical conditions like diabetes, prolonged pain due to an injury, even conventional type of pain management techniques aren’t successful.

Dysfunction of nerve cause neuropathic pain and nerves can get damaged due to a disease or an injury and sometimes the reason for the dysfunction remains unknown. People who suffer with neuropathic pain often experience severe, sharp pain that passes through the pathway of affected nerve. The pain can be followed by numbness, weakness, tingling or burning.

Conventional methods used for pain management focus on pharmaceuticals use and medications available for pain management do not work well for relieving neuropathic pain and also include risk like overdose, addiction and organ damage.

Herbal remedies that work well for neuropathic pain like Corydalis is a plant that yields flowers and is used since ages to treat depression, high blood pressure, menstrual cramps, abdominal pain, spastic intestines and other health problems.  The tuber part and roots of the plant are used. Corydalis can be used for people suffering from neuropathic pain and recent research has shown that a compound known as DHCB is quite effective in getting some relief in case of neuropathic pain.

To avoid side effects more and more people are opting for herbal supplements or remedies to treat naturopathic pain. Some herbs that are effective for relieving naturopathic pain are

Cayenne

It is also called as red pepper and is a spice which is used due to its medicinal properties. Capsaicin is a chemical constituent that gives hotness to the pepper. Capsaicin is basically a pain reliever which is being used since decades to promote circulation, improve digestive problems and encourage appetite. As per the research the medicinal use of cayenne is implemented for reduction of pain related to surgery, arthritis, peripheral neuropathy and nerve neuropathy. Capsaicin is also added to oils, creams and gels for applying on affected areas to get relief from pain.

Magnesium

Magnesium is very important mineral that the body uses for formation of fatty acid, protein, clotting blood, creation of new cells, supporting nerve and muscle function and generating energy in our body. The foods containing magnesium are sea food, dark green vegetables, whole grains, legumes, nuts and they are easily available in food stores.

Chiropractic massage

 People suffering from different types of neuropathic pain get benefited from chiropractic massage taken regularly. Massage loosens the tight muscles and aids circulation and nerve connection and also relaxes your body. You can approach a chiropractic professional and start with regular massage sessions to get relieve from neuropathic pain.

There are many herbal remedies and supplements available for treating neuropathic pain, but you need to find out the right one that suits you. As every person and health differs so the treatment one person is taking might not be suitable for the other.

Knowing About Peripheral Neuropathy

Nerve pain related to foot is a common problem and may cause tingling, numbness, burning sensation or weakness can affect your leg. Nerve pain in your foot occurs as a result of damage caused to the nerve that passes through path from your spine to your foot. This causes due to injury, medical condition or side effect of medication you are taking.

Damage caused to the nerve disables the ability to transmit messages thus causing nerve pain in your foot and it is known as neuropathic pain or neuropathy. Nerve pain in foot causes because of two reasons that is either due to peripheral neuropathy which occurs as a result of damage to the nerve in lower leg or foot it. The other reason for nerve pain in foot is due to problems that occur in lower spine. This results in leg, buttock, back nerve pain including pain in foot and weakness.

Foot Neuropathy Due to Spinal Problems

Nerve pain in the foot normally occurs due to problem in your back rather than in your foot.

Peripheral Neuropathy

When the problem occurs with the function of nerves that regulates the messages from spinal to brain and vice versa.  It causes problems in hands and feet. Peripheral neuropathy can develop

  1. Suddenly: can cause because of a traumatic incident.
  2. Develop gradually: tends to progress over the period of time and becomes chronic, which results in slow improvement.

If the damage occurs to one nerve it is termed as mononeuropathy and if it damages more than one nerve it is known as polyneuropathy.

The damage caused due to peripheral neuropathy results in

  • Weakness: difficulty in moving your leg or lifting up the leg.
  • Pain: stabbing, sharp, electric shock which often worsens during night
  • Altered sensation: pins, numbness, tingling or hypersensitivity. It makes you feel like you have worn a sock when actually you are barefoot.
  • Altered co-ordination and balance

Symptoms affect both feet rather than just affecting one and it progresses gradually.

Causes of nerve pain in foot in case of peripheral neuropathy

  • Medical Conditions: Diabetes is the major cause in case of peripheral neuropathy resulting in diabetic nerve foot pain which causes to imbalanced blood sugar levels which disturbs the metabolism of nerves glucose levels. Any diabetic person should take good care of their feet and report their doctor in case they face burning sensation or foot pain.
  • Injury: This may come from an incident or repetitive compression.
  • Infections: for example shingle, leprosy or Lyme disease.
  • Alcoholism: prolonged intake of alcohol can affect the peripheral nerves
  • Medications: peripheral neuropathy can also occur as a result of side-effect that causes due to medications like chemotherapy drugs.

Nerve pain in foot can become serious when you face weakness for example foot drop wherein you are not able to lift your foot, which causes you stumble or trip while walking. Also if you face numbness in between your legs you should see a doctor.

Causes and Treatment for Neuropathic pain

Neuropathic pain is a type of pain that occurs due to problems that happen with signals that takes place through nerves. The causes are many. The common neuropathic pain occurs due to pressure, burn and injury etc., traditional painkillers like codeine, paracetamol, anti-inflammatories aren’t of much help. Neuropathic pain gets relieved with the help of anti-epileptic medicines and antidepressants.

Neuropathic pain is caused when a problem occurs with one or more than one nerves. The nerve function gets affected in such a way that it starts sending pain messages to your brain. In other words it is also described as aching, stabbing, shooting and similar to electric shock.

There are different conditions that affect the functioning of nerves. This includes the following

  • Cancer
  • Pain that occurs after chemotherapy
  • Facial pain
  • Uncommon disorders in nerves
  • Pain in phantom limb
  • Diabetic neuropathy
  • Pain followed by shingles
  • Alcoholism

Treatment for Neuropathic pain

  1. If possible treating the main underlying cause
  2. Physical treatments
  3. Psychological treatments
  4. Medicines

Treating the underlying cause helps ease down the pain. For example if you are suffering from diabetic neuropathy, then keeping a check on your diabetes to keep in control helps reduce the neuropathic pain. If you are suffering from cancer and if it can be treated, it also reduces pain.

Medicines for neuropathic pain treatment

Common and traditional painkillers

In most cases common painkillers like paracetamol, ibuprofen isn’t much effective in reducing down the pain.

Tricyclic antidepressant

In tricyclic group the antidepressants are used to treat neuropathic pain. It is not actually used to treat depression. These antidepressants actually work on treating neuropathic pain apart from treating depression.

Duloxetine

This antidepressant according to the research has shown good results in reducing neuropathic pain. Duloxetine is proved to be a good treatment for diabetic neuropathy whereas it hasn’t worked well for other types of neuropathic pain.

Opiate painkillers

These painkillers are stronger for example morphine, codeine and other related drugs. These drugs cannot be used for a long-term as it has some side-effects associated with it.

Physical Treatments

Depending on the cause and site of neuropathic pain, a specialist may advise some physical treatments to reduce pain. This may include acupuncture, physiotherapy, PENS etc.

Physiological treatments

Pain can get worse due to stress, depression or anxiety. The feeling of having pain and it becomes impossible for the individual to decide how to react to pain and face circumstances. In such cases pain management programs, therapy related to cognitive behavioral, counseling and stress management plays an important role in reducing neuropathic pain and helping people deal with pain easily.

Neuropathic pain directly affects an individual’s life as he/she needs proper guidance and medical help to recover from pain. If the pain is chronic, it might take a longer period of time but again with right counseling and pain management programs the ability to deal with pain becomes easily and patient can deal with pain positively without getting into depression.

Gabapentin for chronic neuropathic pain and fibromyalgia

This review is an update of a review published in 2011, itself a major update of previous reviews published in 2005 and 2000, investigating the effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage chronic neuropathic pain and fibromyalgia.

OBJECTIVES:

To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain and fibromyalgia.

SEARCH METHODS:

We identified randomised trials of gabapentin for chronic neuropathic pain or fibromyalgia by searching the databases MEDLINE (1966 to March 2014), EMBASE (1980 to 2014 week 10), and CENTRAL in The Cochrane Library (Issue 3 of 12, 2014). We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources, and searched Clinicaltrials.gov. Searches were run originally in 2011 and the date of the most recent search was 17 March 2014.

SELECTION CRITERIA:

Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain or fibromyalgia with assessment of pain intensity, pain relief, or both, using validated scales. Participants were adults.

DATA COLLECTION AND ANALYSIS:

Three review authors independently extracted efficacy and adverse event data, examined issues of study quality, and assessed risk of bias. We performed analysis using three tiers of evidence. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design), second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison, and third tier from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.For efficacy, we calculated the number needed to treat to benefit (NNT), concentrating on at least 50% pain intensity reduction, and Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) definitions of at least moderate and substantial benefit. For harm we calculated number needed to treat for harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. We emphasised differences between conditions now defined as neuropathic pain, and other conditions like masticatory pain, complex regional painsyndrome type 1 (CRPS-1), and fibromyalgia.

MAIN RESULTS:

Seven new studies with 1919 participants were added. Another report (147 participants) provided results for a study already included, but which previously had no usable data. A further report (170 participants) used an experimental formulation of intrathecal gabapentin. Thirty-seven studies (5633 participants) studied oral gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 84% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. There was no first tier evidence.Second tier evidence for the outcome of at least 50% pain intensity reduction, considered valuable by patients with chronic pain, showed that gabapentin was significantly better than placebo in postherpetic neuralgia (34% gabapentin versus 21% placebo; NNT 8.0, 95% CI 6.0 to 12) and painful diabetic neuropathy (38% versus 21%, NNT 5.9, 95% CI 4.6 to 8.3). There was insufficient information in other pain conditions to reach any reliable conclusion. There was no obvious difference between standard gabapentin formulations and recently-introduced extended-release or gastro-retentive formulations, or between different doses of gabapentin.Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin could expect to have at least one adverse event (62%), withdraw because of an adverse event (11%), suffer dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (9%). Serious adverse events (3%) were no more common than with placebo.There were insufficient data for direct comparisons with other active treatments, and only third tier evidence for other painful conditions.

AUTHORS’ CONCLUSIONS:

There was no top tier evidence that was unequivocally unbiased. Second tier evidence, with potentially important residual biases, showed that gabapentin at doses of 1200 mg or more was effective for some people with some painful neuropathic pain conditions. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. About 35% achieved this degree of pain relief with gabapentin, compared with 21% for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief. Results might vary between different neuropathic pain conditions, and the amount of evidence for gabapentin in neuropathic pain conditions except postherpetic neuralgia and painful diabetic neuropathy, and in fibromyalgia, is very limited.The levels of efficacy found for gabapentin are consistent with those found for other drug therapies in postherpetic neuralgia and painful diabetic neuropathy.

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