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Burning, numbness, tingling, hot and cold sensations, shooting and electrical pain are common sensations felt at rest in painful peripheral neuropathy. Neuropathy is an abnormality of the nervous system. There are many different types of neuropathy, but the most common neuropathy effecting diabetics is peripheral neuropathy. Diabetic neuropathy is described as a loss of sensation that starts in the tips of the toes and gradually works its way up the legs, and in severe case into the hands. It is sometimes referred to as a stocking glove neuropathy because it progresses as if one was pulling on a stocking.
Sixty percent of diabetics have some type of neuropathy in their feet. Five percent of diabetics will experience painful diabetic neuropathy and the incidence increases with age. Over 45% of individuals who have had diabetes for over 25 years will experience some symptoms of painful diabetic neuropathy.
The cause of diabetic neuropathy is not clearly understood. Many believe that the damage to the small vessels surrounding the nerves, from the diabetes, causes damage to the nerves. Others believe the increase in blood sugar causes damage to the nerves. Despite the different theories, studies have shown better blood sugar control helps prevent progression of the neuropathy.
There are currently no treatments to help reverse diabetic neuropathy. There are no treatments which help reduce the numbness. But, there are many treatments to help decrease the pain associated with the neuropathy.
doctor may prescribe medications to help with the pain. There are many options,
recently none were FDA approved for
the treatment of painful neuropathy.
Cymbalta ®, duloxetine HCl, was recently approved by the FDA in September
of 2004 for use in diabetic peripheral neuropathy at doses of 60 and 120 mg
per day. This is the first drug approved for this use. Similar medications,
amitriptyline, desipramine and nortriptyline, have been used to help decrease
pain and help with sleep. Gabapentin, also known as Neurontin®, has been
a successful treatment for painful diabetic neuropathy. Neurontin® was
originally approved by the FDA for adjunctive use in seizures, but the benefits
drug for other conditions, like neuropathy, soon became known. The manufacturers
of Neurontin® were caught up in a controversy regarding their marketing
tactics for this off label use. Many physicians still use this drug despite
Tegretol and Dilantin, common seizure medications, can be used in more severe
cases. New treatments include lidocaine 5% cream, acetyl-L-canitine, nerve
growth factor and Annodyne ®, infrared therapy.
Treating painful diabetic peripheral neuropathy is very difficult and many of the above mentioned therapies should be tried and combined. Don't expect any "cures" and make sure you give each therapy a chance to work.
Christine Dobrowolski is a podiatrist, runner, and author of "Those Aching Feet: Your Guide To Diagnosis and Treatment of Common Foot Problems," available via her publisher, SKI Publishing, and at Barnes & Noble and Amazon.com.