Peripheral Neuropathy: Everything You Need to Know
Approximately 20-50% of people with diabetes say they experience painful peripheral neuropathy. Pain associated with diabetic neuropathy can be very severe and it is notoriously difficult to manage.
If you are affected by the condition you will know that it can impact on day to day activities as well as your sleep. Many people report pain is worse at night, causing them to wake repeatedly. Or they find the sensation of sheets touching their feet extremely painful meaning they must sleep without sheets or blankets.
Treatment can be challenging but there are options that can help. A combined approach is often needed.
What Causes Peripheral Neuropathy?
Peripheral neuropathy occurs when nerves in your extremities (feet, hands, lower legs) are damaged. It usually affects the feet first.
Extended periods of high or widely fluctuating blood glucose levels can damage nerves, causing either reduced sensation or causing them to become highly sensitive resulting in pain or intense discomfort. Smoking, high cholesterol and high blood pressure are also thought to contribute to nerve damage.
What are the Symptoms of Peripheral Neuropathy?
People with painful peripheral neuropathy commonly describe symptoms such as burning, tingling, pins-and-needles or a sharp shooting electric-shock like pain. This pain can be worse at night time, interfering with sleep and affecting mood.
Peripheral neuropathy is not always painful. It can also include a numbness or a loss of sensation in the feet. While not painful it may cause a loss of balance and coordination as you are less aware of where your legs, hands and feet are in relation to the rest of your body. This increases the risk of trips and falls.
How is Peripheral Neuropathy Diagnosed?
A diagnosis of peripheral neuropathy is made from a detailed history of your symptoms and a physical examination, which will include testing your feeling with simple instruments such as a thin piece of monofilament and/or a tuning fork. There are other nerve conduction tests that can be performed by a neurologist when the diagnosis is unclear.
How to Treat Peripheral Neuropathy?
The simplest initial treatment is improving your blood glucose levels to prevent any further nerve deterioration. It is important to monitor your levels to maintain targets.
The aim of treatment is to reduce your pain and improve quality of life. Your healthcare team will work with you to plan ongoing support, medications and treatments.
Over the counter pain relief may not be enough when you have painful peripheral neuropathy but unfortunately stronger medications can cause drowsiness and adversely affect your quality of life. Using different medications in combination may be more effective than one medication alone. Your treating team will discuss the best way forward for your individual circumstances.
Other options include the use of a TENS machine that stimulates nerves or even a surgical procedure to stimulate the nerves in the spinal cord.
You may find the use of a bed cradle from a mobility appliance shop helpful if you experience pain from your bedsheets a night. The cradle slips under the mattress and raise the bedclothes off your body. Some people experience relief from wearing heel protection booties. They come in different materials including sheepskin and high-density foam.
A combined approach of adopting positive lifestyle habits, medication and exercise is generally the most effective first step and if you're having particular issues with your feet, see how blog post here for tips to take of your feet.
Final Tips for Peripheral Neuropathy
If you have any problems with your feet, you should discuss them with your healthcare team. Just because it may not hurt doesn’t mean it isn’t causing damage. This is particularly important if you experience a loss of sensation as a result of painless peripheral neuropathy. If you notice a sore, don’t ignore it.
There are a range of dedicated healthcare professionals such as your doctor, podiatrist, diabetes educator, clinical nurse and pharmacist who can help you with advice about the day-to-day management of your diabetes and diabetic neuropathy.