Jenny L. F. Andrus, MD
According to the CDC, 100 million Americans have diabetes or a condition known as pre-diabetes. Type 1 diabetes typically presents in childhood and is more rare, accounting for 10% of all diabetes cases. The more common Type 2, accounting for 90% of cases, occurs in adulthood and can be caused by obesity and the development of insulin resistance. Diabetes has many symptoms, but there are many with the condition who don’t even know that they have it. Uncontrolled diabetes can cause permanent damage to the eyes, kidneys, heart and nerves. As an Interventional Pain Management physician, I don’t treat diabetes, but I do treat patients with diabetes-induced nerve pain.
Diabetic Neuropathy can cause nerve pain which is notorious for causing burning, tingling, unrelenting pain in those who suffer with it. It is unfortunately, one of the most common symptoms of diabetes. Also known as Peripheral Neuropathy, it usually affects nerves in the hands, arms, feet and legs, but can affect nerves elsewhere. Although it can be felt at any time, discomfort typically is worse at night when patients go to bed. The reason for this is that as your brain calms down for the evening, it has more capacity to focus on what hurts and therefore the pain registers as more intense.
I typically see patients when they have tried to manage their nerve pain with help from their PCP, but have not been successful. When you come to see me for a consultation, I will have reviewed your medical records thoroughly, but will ask you many questions about your condition. I will specifically ask about your pain, when it is better or worse, what therapies or medications have you tried and have any of them helped. I will want to know how well you are controlling your diabetes and may refer you for diabetic nutritional counseling, if you are having issues with your diet and managing your insulin doses accordingly.
There are many options for treating diabetic neuropathy. Drugs, such as gabapentin, are known to help calm the nerves and may be helpful. Cymbalta® or other anti-depressants may also give relief. I may try different drugs in combination to address your pain symptoms. The downside is that these drugs may make you sleepy or foggy, so we must carefully find the dosage that helps your pain but doesn’t knock you out. I try to avoid using opioids as usually the risks far outweigh the benefits. Topicals, in the form of gels, creams or patches, may also help. These often have numbing agents and pain medications combined in them for maximum relief.
Some patients try alternative therapies to alleviate their nerve pain. Acupuncture, using essential oils, massage therapy and water therapy are just some of the options for patients to try. Perhaps patients will choose to modify their diet, and eat only organic foods, and those known for their anti-inflammatory properties. I encourage my patients to discuss these options with me first, but I don’t have a problem with alternative treatments that aren’t extreme or dangerous.
TENS units may also be used to treat diabetic neuropathy. A small and portable device produces a gentle electric current which can be applied to painful areas through electrode pads. This is another treatment that gives the brain something else to consider besides the pain coming from the injured nerves. By “tricking” the brain into paying attention to non-painful nerve signals, patients often find that their discomfort is reduced.
Spinal cord stimulation is an effective treatment that can be used for treating the pain of diabetic neuropathy. Because it’s expensive and involves a surgical procedure, it’s a treatment reserved for those patients who’ve been unable to get relief through other therapies. The good news is that patients can try the therapy to see if it provides relief before committing to the permanent, surgical procedure. Most patients have seen a remarkable improvement in their pain and quality of life using neuromodulation. During the trial, patients have a small lead placed into the epidural space of their spine, according to where their pain is most intensely felt. This lead is attached to a small unit that runs a gentle electric current into the space nearest where the corresponding spinal nerves are to the painful area. This signal can be adjusted and turned off or on by the patient by a hand-held remote. The patient tries this at home while going about their daily activities for a week. If they see a marked improvement (we typically look for at least a 50% reduction in pain), then we can discuss permanent implantation of the lead and long-life battery.
In summary, there are many ways I can treat your painful Diabetic Neuropathy. Working together as a team, we can find the therapies that fit into your lifestyle and activity level, to make sure you’re living the best life possible with less pain.
Make an appointment with Dr. Andrus or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.