Painful Diabetic Peripheral Neuropathy

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Dr. Nocerini

Dr. Nocerini, Pain Specialist

For people who have Type 1 or Type 2 Diabetes, the disease comes with a host of other health concerns that must be monitored regularly.

Among the more serious conditions that can result from unchecked or unmanaged diabetes is Painful Diabetic Peripheral Neuropathy.

Dr. Robert Nocerini is a Dallas pain specialist with Texas Pain Relief Group.

“Some people with diabetes will develop Diabetic Peripheral Neuropathy, a condition that affects the nerves in the body, causing a decrease in sensation most commonly experienced in the hands and feet,” Dr. Nocerini said. “It can develop in people with type-1 and type-2 diabetes. A significant proportion of people with Diabetic Peripheral Neuropathy also will develop Painful Diabetic Peripheral Neuropathy.”

The pain may be felt as burning, shooting, stabbing, electric, or dull. It can be worse at night, interfering with sleep. The pain typically starts in the feet and over time progresses up the legs, sometimes involving the hands.

There are a number of options for treating Painful Diabetic Peripheral Neuropathy.

“Initial treatment consists of optimizing blood glucose levels. Three oral medications have FDA approval for the treatment of Painful Diabetic Peripheral Neuropathy are duloxetine, pregabalin, and tapentadol,” Dr. Nocerini explained. “Duloxetine is in a class of medications called Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). Duloxetine is classified as an antidepressant, but it is also effective at treating chronic neuropathic pain. Pregabalin is in a class of medications called antiepileptics. Tapentadol is in the opioid class of medications.”

Topical medications may also be used, such as capsaicin, lidocaine, amitriptyline, or ketamine. These are sometimes better alternatives for people who develop side effects from oral medications, are on other medications that may interact with oral medications, or if they have other medical problems that preclude the use of certain oral medications.

For patients whose pain does not respond to the above medications, Spinal Cord Stimulation is another treatment option.

“Spinal Cord Stimulation may be a treatment option for Painful Diabetic Peripheral Neuropathy when medications are ineffective, or if medication side effects are intolerable,” Dr. Nocerini said. “Spinal Cord Stimulation is a reversible procedure, and patients go through a trial period to see if it works well for them before committing to implanting the stimulator.”

Steps can be taken to minimize the progression of neuropathy. Patients should work with their primary care provider or Endocrinologist to optimize blue glucose control. Symptoms sometimes improve with normalization of blood glucose.

“In some cases, peripheral neuropathy may become evident before the diagnosis of type-2 diabetes, so numbness or pain in the feet should be evaluated by a physician,” Dr. Nocerini said. “As with other chronic pain conditions, attention to basic lifestyle and psychological factors is effective at decreasing pain. These measures include smoking cessation, daily aerobic exercise, and meeting with a pain psychologist.”


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