Diabetic Nerve Pain in Feet

Diabetic nerve pain is also known as diabetic neuropathy and specifically, peripheral diabetic neuropathy.  There are several kinds of neuropathies that a diabetic can get but diabetic nerve pain in the feet is called peripheral neuropathy.  It is extremely common among diabetics, involving about 50 to 70 percent of people who suffer from diabetes. The longer a person has diabetes, the greater is the incidence of diabetic neuropathy.

Diabetic neuropathy is worse in people who have poor control over their diabetes.  Those diabetics who manage to keep their blood glucose levels in good control can have a resolution of their symptoms and may be able to stop taking treatment for their diabetic nerve pain.

The people who have the greatest incidence of diabetic nerve pain in their feet are those who have had their diabetes for more than 25 years.  Diabetic nerve pain is also more common in those diabetics who have high cholesterol and triglyceride levels, high blood pressure, and in those diabetics who are obese or overweight.

Symptoms of Diabetic Nerve Pain in Feet

Common symptoms of diabetic neuropathy include the following:

• The feeling of “pins and needles” in the feet
• Tingling of the feet
• Numbness of the feet
• Stabbing, burning, or shooting pains in the feet
• Sensitivity of the feet to touch
• The feeling that one has socks or gloves on when there are none
• The sensation of pain worsening at night
• The feeling of excessive coldness or heat in the feet and hands
• A dead feeling in the feet
• Weakness of the muscles of the legs
• Unsteadiness when walking
• Being unable to feel hot or cold sensations in the feet
• The inability to feel the feet on the floor
• Misshapen bones and/or muscles of the feet
• Open sores or ulcers in the legs or feet that do not heal or heal very slowly

Diagnosis of Diabetic Nerve Pain

The doctor can diagnose diabetic nerve pain just by listening to your symptoms and doing a clinical examination.  One test that is done is called a “two-point discrimination test”.  This is where the doctor uses a device like a paperclip that is touched on various parts of the foot and toes.  The doctor asks whether the patient feels two touches with the paper clip or just one touch.  If the patient cannot tell the difference, it is likely that they have diabetic neuropathy.

The doctor will also inspect the feet for open sores and atrophy (thinning) of the skin of the toes and feet.  In some cases, nerve conduction studies can be done, which will show decreased nerve activity in the nerves of the feet and toes.  Vibration sensation can be checks by using a tuning fork to see if the diabetic patient can feel the vibration of the tuning fork.  If they don’t feel it, it may be from diabetic neuropathy.

Another test for diabetic neuropathy is an electromyogram or EMG. It uses needles inserted into the muscles of the feet to see if the muscles are reacting to nerve signals.  If the test shows low reactivity of the muscles to nerve signals, it may be from diabetic neuropathy.

Treatment of Diabetic Neuropathy

The best way to get rid of diabetic nerve pain in the foot is to keep the blood sugar levels in good control.  When the glucose levels are normal, the nerves are not damaged and can regenerate, resulting in a resolution of symptoms.  Keeping the blood sugars in control means monitoring the blood glucose levels on a regular basis, eating foods that are low in fat and sugar, getting more exercise, and taking diabetic medications and/or insulin to keep the blood sugar down.

Sometimes the symptoms get worse right after getting the blood sugars in control.  No one knows why this happens.  After a period of time, however, the symptoms get better and the diabetic neuropathy resolves itself.

Medications can be used to treat the pain of diabetic neuropathy.  There are a variety of medications, many of which aren’t considered to be pain medications at all.  Commonly used medications for the management of diabetic nerve pain include the following:

• Antidepressants, including Cymbalta (duloxetine), Wellbutrin (bupropion), Paxil (paroxetine), Celexa (citalopram), and venlafaxine.
• Tricyclic antidepressants—these are older antidepressants that are very effective in treating pain. Some of these antidepressants include Norpramin (desipramine), amitriptyline, and imipramine.
• Anticonvulsant medications, including Lyrica (pregabalin), Neurontin (gabapentin), carbamazepine, and Lamictal (lamotrigine).
• Opiate medications, such as OxyContin (extended relief), Ultram (tramadol), and other narcotic medications.

Many of these drugs are not used to actually treat diabetic nerve pain but are indicated for another medical reason.  This is called “off-label use” of a medication.  The only two drugs that have been approved by the US Food and Drug Administration for peripheral neuropathy are pregabalin and duloxetine.

When antidepressants are used to treat diabetic foot pain, it does not mean that you are depressed.  The medication acts on the brain, reducing the perception of pain so the burning pain isn’t as bad.  These medications do have side effects, particularly in elderly adults or people who have heart problems.

Medications you buy over the counter, such as acetaminophen, ibuprofen, and naproxen sodium are considered to be not strong enough to manage this type of pain so rarely would a doctor recommend using them to treat diabetic nerve pain.

Other treatments for diabetic nerve pain are topical capsaicin cream and topical lidocaine patches.  There have been some research studies on the application of nitrate patches or the use of nitrate sprays for treating this type of pain with some success.  Alternative therapies for diabetic nerve pain in the feet include evening primrose oil, and alpha-lipoic acid.

Some people have benefit when they use a bed cradle when they sleep.  A bed cradle prevents the blankets and bed sheets from touching the feet and legs during sleep so the patient can sleep better with their diabetic foot pain.  Other alternative therapies that have been tried include physical therapy, magnetic therapy, biofeedback, and acupuncture.  There is ongoing research on other treatments as well.

References:

• Diabetic neuropathy. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/peripheral-neuropathy.html.
• Diabetic Neuropathies: The Nerve Damage of Diabetes. http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx.