Diabetic Neuropathy: Types, Causes, & Pain Management Options

diabetesDiabetes can cause multiple problems in the body.  High blood sugars can cause damage to nerves.  Diabetic neuropathy occurs in up to 70% of diabetics, and is painful in up to 30%. There are four common types of diabetic neuropathy: 

  1. Peripheral polyneuropathy
  2. Autonomic neuropathy
  3. Amyotrophy mimicking a radiculopathy
  4. Mononeuropathy

The small sensory pain fibers are the most commonly affected, causing pain in the feet and slowly progressing to the legs and often developing in the hands.  Loss of sensation in the legs can lead to open wounds, infections, amputations, and sometimes even death.

Causes of Diabetic Neuropathy

The causes of diabetic neuropathies are all thought to start with high blood sugars.  This is known to cause damage directly to the nerve, the insulation covering the nerves, and the blood vessels that provide nutrition.  There is also thought to be an auto-immune factor that diabetes provokes our immune system to fight the body itself like a foreign organism and cause damage.  Smoking and alcohol can also increase the likeliness of damage.  Lastly, diabetes makes the nerves more sensitive to damage, thus injury can cause significant increase in overall damage to nerves.

Peripheral Polyneuropathy

Peripheral polyneuropathy is the most common type of damage seen in diabetes.  It is noticed first affecting sensory nerves, but motor nerves can be equally damaged.  People often first notice numbness in the feet and toes, and changes in temperature.  Tingling, and burning is common, as well as pain and sensitivity even to the lightest of touches.   Motor changes include weakness in the feet and legs and difficulty with walking and balance.

Autonomic Neuropathy

Autonomic neuropathy is the next most common diabetic neuropathy.  The nerves that control the heart, bladder, stomach and intestines, sex organs, and eyes are from the autonomic nervous system.  Loss of control of the bladder may be from damage to these nerves.  In males, erectile dysfunction is a common issue.  Stomach problems include slow emptying, constipation, and sometimes diarrhea.  Heart problems include fluctuating blood pressures and heart rates.

Prevention & Treatment Options

Once diabetic neuropathies occur, they are often hard to manage and control, since the nerve damage is often permanent.  Good blood sugar control is the most important aspect in reducing the incidence and severity.  Painful neuropathies are best treated with neuropathic medications such as:

  • Gabapentin
  • Lyrica
  • Cymbalta

Narcotic/opioid medications are often only minimally helpful at best.  In the worst cases, implantable pain control devices such as spinal cord stimulation and intrathecal pain pumps are useful.  When pain is an ongoing problem, enlisting the help of an experience pain physician can be a lifesaver in symptom management.

Managing Foot and Ankle Pain After Surgery

foot pain after surgeryFoot and ankle surgery is common for deformities such as fractures and sprains. Pain is an unavoidable part of surgery recovery. That being said, there are methods you can use to manage the pain. Understanding the significance of the pain, the cause, and the severity is the key to correct management.

Injuries to the ankle and foot, as well as any resulting surgery, causes acute pain that can be directly correlated to the damaged structured.  After surgery, pain is related to damage and inflammation of tissues.  As structures heal, the pain will resolve quickly.

Pain from Foot & Ankle Surgery

Surgery for the foot and ankle is similar to an injury – it causes damage to tissue but it is done to correct an abnormality in order to reduce problems in the future.  Pain related to surgery is from the incisions and tissue manipulation, which stimulates the sensory nerves and inflammation.  Post surgery, treating pain with anti-inflammatory medications along with analgesics is often necessary.

Pain is normal, but should be easy to control and will dissipate as healing progresses.  Icing for the first 2 days after surgery and keeping the foot elevated keeps the inflammation, swelling, and pain under control.  The most important thing to do post-surgery is to follow the doctor recommended activity restrictions. This will improve your recovery speed.

Hypersensitivity and CRPS

Damage to the foot and ankle in about 5% of cases can cause severe, abnormal pain with hypersensitivity.  When this occurs, special pain management is necessary.  Sympathetic hypersensitivity, know as Complex Regional Pain Syndrome (CRPS – “crips”) causes severe extremity pain and despite normal treatment, it still hurts.

This condition requires a high level of intervention with medications, special therapy, and nerve blocks before and after any surgery and recovery requires the skills of an experienced team of an orthopedic surgeon and a pain management specialist. Many physicians “give up” when they see these issues with ankle and foot injuries, but when treated aggressively and correctly, these injuries can be significantly corrected.  Having the best team to treat foot and ankle issues reduces or eliminates long-term problems.