Diagnosis of neuropathy The term “signs” in the medical field is used to indicate finding that a medical provider looks for on the physical examination to reach a diagnosis. These are explained below in the case of a physical examination to diagnose diabetic neuropathy. For “symptoms”, which in the medical field is the term used to describe your complaints such as numbness, tingling and pain, please refer to the article on “symptoms of neuropathy”.
When a medical provider performs a physical examination to evaluate for diabetic neuropathy, the examination often begins with an assessment off sensation in the upper and lower limbs. Your ability to feel light touch as well as pinprick sensation is assessed. One of the earliest clinical signs of diabetic peripheral neuropathy or polyneuropathy is a decrease or loss of pinprick sensation, followed by decrease or loss of light touch sensation. This is followed by loss of vibration feeling. The feeling of vibration is tested using a tuning fork. Loss of sensation in the “glove and stocking” distribution is often the term used to describe the manner in which most people develop peripheral neuropathy or polyneuropathy. There can be loss of sensation in other parts of the body as well like the chest, trunk or pelvic areas. When neuropathy worsens beyond loss of sensation, there is progression to actual weakness. The remaining part of the “neurological” or nerve testing examination includes an assessment of strength in the upper and lower limbs to look for any weakness.
The physical examination usually also includes testing of deep tendon reflexes, like the ‘knee jerk’. When peripheral neuropathy or polyneuropathy is present, the reflexes can be decreased or absent due to the damage of nerves. But one should keep in mind that it is possible for reflexes to be diminished or absent in certain healthy people as well. Therefore, it is most helpful for your physician to be able to compare your reflexes over time, to see if there is any change from your usual reflexes.
The examination for neuropathy should also include an evaluation of the skin and circulation in the feet and legs, and hands and arms. Changes in the skin color, texture, hair growth, wounds, etc can indicate the severity of neuropathy, and may need treatment.
Certain special functions like vision, taste, smell, movement of the facial muscles, muscles that allow speech, chewing, swallowing, etc are performed with the help of special nerves directly from the brain, called “cranial nerves“. These nerves may also be tested during the complete examination for neuropathy.
Since diabetes can also affect blood circulation, blood vessel pulsations in the feet, legs, hands and arms are usually checked during a physical examination for neuropathy. Most physical examinations will usually also include a check of blood pressure and heart rate, as well as listening for abnormal heart sounds or lung sounds.
Many doctors and medical providers would also check your balance and coordination, since these functions can be affected when neuropathy is present.
If your complaints involve certain organ functions like urinary or bowel problems, sexual problems, etc, or if your doctor suspects that you may have one of the neuropathies that affect specific organs in the body like the bowels, bladder, etc. then there are specific tests on physical examination that the medical provider will want to perform to better evaluate those organ functions.
Since diabetic neuropathy can affect nerves anywhere in the body, a proper physical examination will help reveal any abnormalities or affected areas. Depending on the finding, the medical provider might find it necessary to have certain special tests performed like blood tests, nerve conduction study, electromyography, etc. These will be discussed further in the article ‘Special tests for neuropathy’.
Treatments for neuropathy We will cover many different treatment options on this website. To avoid feeling overwhelmed by the information, we feel that the best way to think about treatment approaches and options for diabetic peripheral neuropathy or polyneuropathy is by dividing the treatments into groups. It is then easier to understand the goal of each treatment. Some treatments have multiple goals. For example, Tai Chi helps motor symptoms (through improving balance, strengthening) and mood (through relaxation, meditation). Cymbalta helps with sensory symptoms (pain, numbness, tingling) as well as mood (has anti-depressant effects). We are confident that you will find this method of looking at the various treatment options very helpful. To read about the details of each treatment, please go to the article/post on that particular treatment.
1. Treatments to control blood sugar: This is the first and most important step that you can take to control neuropathy. In has been proven that better blood glucose control results in better control of neuropathy symptoms (less numbness, tingling, pain, weakness, etc).
- Medications for blood glucose control
- Special diets for diabetics
- Exercise treatments
- Relaxation and meditation
2. Treatments for sensory symptoms (numbness, tingling, pain)
- Oral Medications for numbness, tingling and nerve pain: Modern medications used in the medical field and considered to be effective specifically for numbness, tingling and nerve pain symptoms associated with neuropathy are Gabapentin (brand name is Neurontin), Nortriptyline (amitriptyline is similar but with slightly more side-effects), Pregabalin (brand name is Lyrica), Duloxetine (brand name is Cymbalta). There are many other medications, from acetaminophen, ibuprofen and naproxen to narcotics. More details can be found in the articles about these medications.
- Topical creams, ointments, lotions and patches for numbness, tingling and nerve pain: Capsaicin, Lidoderm patch.
- Supplements and herbal treatment
- Desensitization:
- Acupuncture
- Sympathetic nerve blocks:
- Spinal cord stimulator
3. Treatments for motor symptoms (weakness, clumsiness, loss of position sense or ‘proprioception’)
- Self-exercise programs: Tai-chi
- Physical therapy
- Occupational therapy
4. Treatments for effects on neuropathy on mood (depression, anxiety)
- Qi-gong
- Lifestyle change
- Meditation
- Psychotherapy and counseling
- Medications for depression
- Medications for anxiety
Treatments for neuropathy
We will cover many different treatment options on this website. To avoid feeling overwhelmed by the information, we feel that the best way to think about treatment approaches and options for diabetic peripheral neuropathy or polyneuropathy is by dividing the treatments into groups. It is then easier to understand the goal of each treatment. Some treatments have multiple goals. For example, Tai Chi helps motor symptoms (through improving balance, strengthening) and mood (through relaxation, meditation). Cymbalta helps with sensory symptoms (pain, numbness, tingling) as well as mood (has anti-depressant effects). We are confident that you will find this method of looking at the various treatment options very helpful. To read about the details of each treatment, please go to the article/post on that particular treatment.
1. Treatments to control blood sugar: This is the first and most important step that you can take to control neuropathy. In has been proven that better blood glucose control results in better control of neuropathy symptoms (less numbness, tingling, pain, weakness, etc).
- Medications for blood glucose control
- Special diets for diabetics
- Exercise treatments
- Relaxation and meditation
2. Treatments for sensory symptoms (numbness, tingling, pain)
- Oral Medications for numbness, tingling and nerve pain: Modern medications used in the medical field and considered to be effective specifically for numbness, tingling and nerve pain symptoms associated with neuropathy are Gabapentin (brand name is Neurontin), Nortriptyline (amitriptyline is similar but with slightly more side-effects), Pregabalin (brand name is Lyrica), Duloxetine (brand name is Cymbalta). There are many other medications, from acetaminophen, ibuprofen and naproxen to narcotics. More details can be found in the articles about these medications.
- Topical creams, ointments, lotions and patches for numbness, tingling and nerve pain: Capsaicin, Lidoderm patch.
- Supplements and herbal treatments
- Desensitization:
- Acupuncture
- Sympathetic nerve blocks:
- Spinal cord stimulator
3. Treatments for motor symptoms (weakness, clumsiness, loss of position sense or ‘proprioception’)
- Self-exercise programs: Tai-chi
- Physical therapy
- Occupational therapy
4. Treatments for effects on neuropathy on mood (depression, anxiety)
- Qi-gong
- Lifestyle change
- Meditation
- Psychotherapy and counseling
- Medications for depression
- Medications for anxietY
Diagnosis of neuropathy The answer to the question “Do I have diabetic neuropathy?” is not always straight-forward. There are many other conditions that can cause similar symptoms and signs. A medical specialist can usually help answer this question for you based on your symptoms, examination signs and test results. But you too play a critical role in passing along the relevant information to your doctor to help in making the right diagnosis, and in understanding your condition. Also, you are your own best advocate and it makes sense for you to be a well-informed patient about your condition. Say for example your house needed some repairs. Would you spend your hard-earned money on repair work on your house without first learning as much as you can about the problem and the options to solve the problem. Similarly, it makes sense for patients with neuropathy (or any medical condition) to do the research so that they can ask the appropriate questions and stay actively informed informed about their medical condition. This can definitely translate into an accurate diagnosis and better treatment of the problem. WE ARE HERE TO HELP. This website can help in several ways.
1. Understand ‘What is diabetic neuropathy’ by reading the article on this topic. Then you will be able to better participate in the discussion about neuropathy with your doctor, and will also understand many of the medical terms used in your medical reports, books, websites, discussions, etc.
2. Learn about the different types of diabetic neuropathy and the symptoms, then compare with your own situation. You can find this information in the article ‘What are the different types of diabetic neuropathy’ and ‘Symptoms of diabetic neuropathy’.
3. If you would like to understand what your doctor looks for when he/she examines you, then you can read about the different signs that can appear when someone has neuropathy and what each sign means. You can even look to see if you have these signs before you see the doctor.
4. Do you need additional testing? What types of tests are performed when diabetic neuropathy is suspected and when should they be performed? Do all patients suspected to have diabetic neuropathy have all those tests performed? Answers to these questions can be found in the several articles about the various tests in the ‘Tests and Diagnosis’ section.
5. Finally, I am sure you will be interested in knowing the different treatment options. But do all types of neuropathy need treatment? Can the symptoms of neuropathy just get better on their own? For the more troublesome and painful types of neuropathy, is medication the only options or are there non-medication options as well? Before discussing treatment with your doctor, we strongly recommend that you make yourself aware of the ENTIRE RANGE of treatments available, so that you can ask your doctor why they are recommending certain treatments and not others,and what will be the entire plan of treatment for you.
Conclusion
Knowledgeable patients who have made the effort to learn more about their condition, tend make better and more informed decisions about their care. Although there is no replacement for a face-to-face consultation, examination and sometimes additional testing under the supervision of a medical specialist, it is also important to be informed and aware of the various symptoms, signs, diagnostic tests and then the treatment options.
Diagnosis of neuropathy To get the most out of this article, we strongly encourage you to first read the article/post on ‘What is diabetic neuropathy?’ to understand the various nerve types in the body, normal function of the different nerves in the body, how they can be affected by diabetes, and the various medical terms used to explain neuropathy.
Is there more than one type of diabetic neuropathy?
Diabetes can damage almost any type of nerve in the body. Depending on the type of nerves affected by diabetes, symptoms of neuropathy can vary from person to person. The different types of nerves in the body are explained in the article ‘What is diabetic neuropathy?’ Some people have several different symptoms of neuropathy due to damage to different types of nerve. Others may have only one type of neuropathy. The most common form of diabetic neuropathy is peripheral neuropathy or polyneuropathy.
Types of diabetic neuropathy and SYMPTOMS of each type of neuropathy
Some people will have only one type of neuropathy if only one type of nerves is affected. Others may have several different groups of symptoms of neuropathy due to damage to more than one type of nerves. The most common form of diabetic neuropathy is peripheral neuropathy or polyneuropathy.
Diabetic peripheral neuropathy or polyneuropathy: When diabetes affects the nerves in the feet, hands, legs or arms, which carry sensations of touch, temperature, pain, balance, etc (sensory nerves) or the nerves which control muscle movements in the legs or arms (motor nerves), this type of neuropathy is called diabetic polyneuropathy (‘poly’ is the term used to indicate ‘multiple’, thereby meaning that polyneuropathy is a condition affecting multiple nerves) or diabetic peripheral neuropathy (the term ‘peripheral’ is used to indicate that nerves at the ‘periphery’ of the body are affected, for example the feet or hands, sometimes spreading to the legs or arms).
As explained in the article ‘What is diabetic neuropathy?’, nerves in the feet, hands, legs and arms may be ‘sensory nerves’ or ‘motor nerves’. Depending on which of these two types of nerves or both, are affected, one may have either sensory neuropathy or motor neuropathy.
* Sensory peripheral neuropathy or sensory polyneuropathy causes loss or altered sensation of touch, temperature or position sense. This results in numbness, tingling, clumsiness or balance problems. There can also be altered sensation of pain causing either loss of the ability to feel painful sensations, or constant feeling of pain in the affected area. Some people will develop a sign in which the affected part (foot, hand, arm or leg) is very sensitive to touch. In medical terms, this is called ‘hyperaesthesia’. When there is actual pain to even light touch, this is an even worse sign called ‘allodynia’. People who have developed allodynia find it painful to wear socks, shoes or even have a bed sheet touch the affected foot or hand. Medical specialists use these terms to describe the signs of neuropathy- these and other signs used by doctors and other medical providers will be discussed in depth in the article ‘Diagnosis of diabetic neuropathy’. The most commonly affected part of the body is the feet. The neuropathy can spread to affect the legs as well. It can also affect the hands and feet.
* Motor peripheral neuropathy or motor polyneuropathy is the term given to the type of neuropathy that affects the ‘motor nerves’ and causes weakness of the feet, legs, hands or arms.
* Mixed (sensory and motor) peripheral neuropathy or polyneuropathy is the term used when a person has both sensory and motor neuropathy.
Usually the early symptoms of diabetic polyneuropathy or peripheral neuropathy are numbness and tingling (sensory neuropathy). At this stage, all attempts should be made to prevent further progress of the neuropathy. Preventive as well as treatment methods have been discussed in other articles on this website. If the neuropathy progresses, then hyperaesthesia and allodynia may develop. Further progression results in weakness (motor neuropathy). Diabetic peripheral neuropathy does not alway follow this sequence. Some people may experience a more rapid progression to the motor neuropathy. In others, there is sudden development of weakness in muscles controlled by a single nerve or a group of nerves. This is called ‘focal neuropathy’, discussed below along with some other types of neuropathy.
Other types of diabetic neuropathy are less common than peripheral neuropathy or polyneuropathy, but need to be mentioned.
One form of neuropathy called focal neuropathy involves sudden or rapid development of weakness in muscles controlled by a single nerve or a group of nerves. This can affect any part of the body, and may or may not be associated with pain.
In the condition called autonomic neuropathy, nerves that help control body functions are affected. Indigestion, nausea, vomiting, diarrhea or constipation can occur when the nerves to the stomach and intestines/bowel are affected. Abnormally high or low blood pressure can cause dizziness or fainting when the nerves that help control the heart and blood circulation are affected. Similarly, some other bodily functions that can be affected by diabetic neuropathy and cause problems are urinary retention (nerves to bladder affected), erectile dysfunction in men and vaginal dryness in woman (nerves to genital organs affected).
Conclusion
Thank you for reading this article, and we hope that you now have a good understanding of the possible symptoms associated with the different types of diabetic neuropathy, especially peripheral neuropathy or polyneuropathy. We would recommend that you next read about the clinical ‘signs’ and tests that doctors and other medical specialists use to diagnose diabetic neuropathy, in the article ‘Diagnosing diabetic neuropathy’. Or you may browse the other topics on this website related to diabetes and foot pain.
General Introduction
Diabetes mellitus has become one of the commonest chronic medical conditions affecting people everywhere today. Unfortunately, diabetes is associated with several possible medical ‘complications’. One of these complications is damage to nerves called ‘neuropathy’ (neuro=nerves, pathy=disorder). Neuropathy can often be prevented, delayed and even controlled with good blood glucose control. However, when severe, special treatments are required to help with the symptoms of neuropathy.
This article will first discuss the normal role of nerves in the body. Then we will see what happens when nerves malfunction. This will be followed by a discussion of how and why nerves get damaged in diabetes. You can also find detailed articles about various treatments for neuropathy by browsing this website.
What is the normal function of nerves in the body?
The human body is very complex. Just for the purpose of this discussion, let us compare a robot to the human body (the human body is far more complex and sophisticated than a robot, but we are making this example just for learning and understanding reasons, so please do not be offended by this comparison). This robot’s name is Su-man. There is a central super-computer that controls Su-man’s every function and movement. There are wires that runs between this super-computer and every other part of Su-man’s body: its arms, legs, eye-cameras, etc. Su-man is a very advanced robot. If something bumps into it or someone touches it, that sensation is carried by special ‘sensory’ (sensation) wires to the super-computer in its head. There are also different wires that run from the brain to Su-man’s arms and legs that can tell the arms and legs to move so that Su-man can run away or defend itself from danger. These wires are called ‘motor’ (movement-controlling) wires.
As you guessed, in the case of the human body, the super-computer is the brain. The ‘sensory wires’ that carry sensations like touch, temperature, position of an arm or leg in space, etc are called ‘sensory nerves” which run from the arms, legs, and other parts of the body to the brain. The ‘motor wires’ are that carry instructions from the brain to the arms and legs telling them to move, are called ‘motor nerves’. There are other types of nerves too which carry information to the brain, or instructions from the brain that help control functions like sweating, blood circulation, hormones release, digestion, sexual function, urination, bowel or stool movement, etc.
What happens when nerves are damaged in the body? What are the symptoms of diabetic neuropathy?
As you have seen in the paragraph above, different types of nerves help control body function. Certain nerves carry sensations like touch, temperature, and position of an arm or leg in space. When these ‘sensory’ nerves are affected or damaged, the effects can be numbness, tingling, incoordination, clumsiness, increased risk of falls and bumping into things. Damage to these nerves can also alter the sensation being carried by these nerves. So for example, instead of carrying light touch sensation from the feet to the brain, the damaged nerves carry wrong signals to the brain which make that sensation feel like pain instead of touch. This is the reason why some people with diabetes find it so painful to wear socks, or even have a bed sheet touch their feet.
Similarly, when nerves carrying movement or motor signals to muscles get damaged, the effects are weakness in the feet, legs, hands or arms. This can affect functions like writing, lifting, standing, walking, etc.
Diabetic neuropathy can also affect nerves which help coordinate other functions in the body like nerves that help control blood circulation, hormones release, digestion, sexual function, urination, bowel or stool movement, etc. For example, diabetic neuropathy can affect the nerves controlling vision, which can cause blurring of vision. When severe, loss of vision can occur, but this can often be prevented by following the Preventive measures discussed elsewhere in this website. When diabetic neuropathy affects the stomach, it is often called diabetic gastroparesis. There is slowing of stomach emptying, and effects on digestion and intestine function.
How and why does diabetes damage nerves in the body?
The exact reason for damage to nerves due to diabetes has never been proven. What scientists and medical research have proven is that there is a direct relationship between high blood glucose and neuropathy. This means that medical research has shown that people who have high blood glucose levels tend to develop neuropathy earlier and to a more severe degree than people who have closer to normal levels of blood glucose. When the blood glucose is better controlled or brought closer to normal, the effects of neuropathy decrease and there is also less spread or worsening of neuropathy. This implies that it is either the higher than normal blood glucose itself, or certain chemicals in the body affected by high blood glucose that cause the damage to nerves in the body. It is also known that diabetes affects blood circulation in the body. Nerves need nourishment from blood just like most other organs and parts of the body. Very tiny blood vessels carry blood to the various nerves in the body. Poorly controlled diabetes can cause narrowing of these blood vessels affecting the blood supply to the various nerves. When nerves do not receive adequate blood supply, they start to malfunction.
We hope this article was helpful in understanding the normal function of nerves in the body, how diabetes affects nerves, and answered your question “What is diabetic neuropathy.” For additional information about symptoms, how to prevent or better control neuropathy symptoms, diagnosis, reviews of various treatments and options, please browse the other topics and articles on this website. Thank you for reading.
Treatments for neuropathy Introduction
Although there are many different treatment options available to help control nerve pain (neuropathy) due to diabetes or other causes, for some people these usual treatments provide inadequate or unsatisfactory pain relief. We are all aware that uncontrolled pain can make life quite miserable and no one deserves to be in that situation. For those of us in this unfortunate situation, there is another resort. Spinal cord stimulation has been becoming an increasingly popular treatment. The technology has actually been available for decades and is a medical treatment covered by Medicare, medicaid and most other health insurance providers, but there seems to be a lack of awareness about this treatment method.
What is the spinal cord stimulator?
The spinal cord stimulator is a device to help control nerve pain (neuropathy) from diabetes or other causes of injury to nerves. It is an electrical device that uses tiny electrical signals to stimulate nerves in the spinal cord and replace painful sensations with a different sensation that can be pleasant, which overrides the pain. Some people hear the words “electrical device” and think that the spinal cord stimulator is similar to a TENS unit (go to this link to read about TENS unit), however the effect is extremely different from the TENS unit.
How does it work?
All sensations like touch, temperature and pain are transmitted from the feet and legs as electric-like signals that are carried by nerves to the spinal cord, and through the spinal cord to the brain which senses these feelings. In diabetic neuropathy or other conditions that damage nerves, abnormal pain sensation signals are carried through these nerves to the spinal cord and ultimately the brain, instead of normal sensations. The spinal cord stimulator involves insertion of 1 or 2 (sometimes 3) thin and soft wires called ‘leads’ or electrodes into the space surrounding the spinal cord (‘epidural space’) with the help of X-ray guidance. These leads or electrodes are connected to a tiny battery about the size of a cell phone battery. The battery is controlled by a handheld remote control which is about the size of a cell phone. With the remote control, the battery can be made to send small electrical signals to the leads, which in turn stimulate the spinal cord to send signals to the brain. So instead of sending the signals for painful sensations from the feet and/or legs, the spinal cord now sends the non-painful signals from the spinal cord stimulator to the brain. In this way, the spinal cord stimulator blocks painful signals from reaching the brain.
Will it be covered by my health insurance?
The spinal cord stimulator treatment is approved by almost all health insurance companies as well as Medicare and Medicaid. The medical provider who is usually an interventional pain management specialist will obtain pre-authorization or pre approval from your health insurance company before proceeding with the spinal cord stimulator treatment for your pain. Most health insurance companies including Medicare require a psychological screening to be done before the spinal cord stimulator trial. Many people who suffer from severe pain do also suffer from depression related to being in constant pain, and therefore depression or other mental health issues are usually not a problem in getting approval. The psychological screening is usually a just a prerequisite to make sure that the person does not have such severe mental health problem that is would interfere with their ability to use or operate the spinal cord stimulator.
Is spinal cord stimulation safe? What are the advantages and disadvantages?
Spinal cord stimulator treatment is backed by many years of research. It is a medically approved treatment by the Food and Drug Administration (FDA) since the 1980s. In addition to painful neuropathy from diabetes or other causes, it is also approved for certain other painful conditions that do not respond to usual treatments, such as ‘failed back surgery syndrome’, radiculopathy (severe pain in the arm or leg related to problems in the neck or low back), peripheral vascular disease (leg pain due to poor blood circulation), complex regional pain syndrome (CRPS) which is also know as reflex sympathetic dystrophy (RSD). Many people have described spinal cord stimulation as a “life changing” treatment for their pain.
Although the spinal cord stimulator is considered a safe treatment, it should be obvious that whenever a device is placed in the body, there are is always the possibility of complications and certain risks. The chance of serious complications like infection, bleeding, paralysis are quite rare when performed by experienced interventional pain management physicians or certain spine surgeons experienced with spinal cord stimulator insertion. This procedure is performed under sterile conditions just as if a surgery were being performed. The chance of being allergic to the leads is also quite rare, but is a possibility that could require removal of the leads. Headache is a possible complication from the procedure. If you had a fall or some other occurrence that caused the leads to move, then this is called lead migration. This can often be corrected without having to actually reposition the leads in the spine area, by just re-programming the way the electrical signals flow from the leads. But sometimes if the leads have migrated or moved significantly, then the physician may have to reposition the leads which would have to be done as a procedure under X-ray guidance. In the long term, the battery may need to be replaced after some years of use. There are also some people who feel that the beneficial effects of the spinal cord stimulator decrease after several years of use.
Which specialist should I work with for spinal cord stimulator treatment?
The specialists who usually have the most experience with spinal cord stimulators are called ‘Interventional pain management physicians’. They usually work in pain clinics. In some areas, spine surgeons perform both the trial as well as the permanent implant of spinal cord stimulator.
How do I know if the spinal cord stimulator will work for me? What is the spinal cord stimulator ‘trial’?
You get to try out the spinal cord stimulator before a permanent implantation of the spinal cord stimulator. This ‘trial’ of the spinal cord stimulator involves the pain management physician inserting one to three leads through a needle (usually no incision or surgery involved for the trial) with the help of X-ray to position the leads outside the spinal cord. The needle is then removed, and the lead/s come out of the skin from the back, and are covered with a dressing. The lead/s are attached to the battery which is worn on your belt or kept in your pocket for the duration of the trial. (Keep in mind that if you do end up having the permanent spinal cord stimulator, these leads and the battery are also under the skin, and nothing is outside the body other than the remote control which you may carry in your pocket of bag). You then get to try out the spinal cord stimulator for 5-7 days. You then return to the clinic to discuss the results of the trial with your doctor. The leads inserted for the ‘trial’ will be removed at the end of the trial period. If you felt the spinal cord stimulator helped greatly in decreasing your pain during the trial period, then you can go ahead with a permanent stimulator. On the other hand, if you feel that during the trial period the spinal cord stimulator did not really help much, then there would not be any point in going ahead with the permanent implant.
What are the steps to receive a spinal cord stimulator?
1. You are already taking the first step by educating yourself about the spinal cord stimulator treatment by reading this article.
2. Make a list of questions for your pain management physician or talk to your primary care provider about getting a referral to a pain management physician who is experienced with spinal cord stimulation. The specialists who usually have the most experience with spinal cord stimulators called called ‘Interventional pain management physicians’. They usually work in pain clinics. In some areas, spine surgeons perform both the trial as well as the permanent implant of spinal cord stimulator. The interventional pain physician will perform an evaluation to assess if you a candidate for a trial of spinal cord stimulation.
3. You will be referred for a psychological screening which is a requirement by almost all health insurance companies before they will pre-approve or authorize coverage for the spinal cord stimulator trial. You will not be denied the treatment if you suffer from depression or any other psychological disorder. Many people who suffer from severe pain also suffer from depression due to being in constant pain, and therefore depression or other mental health issues are usually not a problem in getting approval. The psychological screening is usually just a prerequisite to make sure that the person does not have such severe mental health problems that it would interfere with their ability to use or operate the spinal cord stimulator.
4. Once authorization or prior approval has been obtained from your health insurance company that they will cover the spinal cord stimulator treatment for you, you will receive the trial of spinal cord stimulator, followed by the permanent implant if you feel the trial was very helpful in controlling your pain.
Conclusion
We hope this article provided you with all the necessary information about this rather complicated topic of spinal cord stimulation in an easy to understand manner. We encourage you to ask questions. We can answer any questions that you may have about this topic through the ‘comments’ section of this website. Please remember that this is information and any information on this website cannot and should not substitute the advice you get from a medical provider that is specific to your situation. Thanks for reading.
Medications for neuropathy Gabapentin was first introduced as a drug to treat epilepsy. Over the years, it has become recognized and very well accepted in the medical field as a medication to treat a variety of pain conditions, especially ‘nerve pain’. The main benefit of this drug is that it is very unlikely to cause any injury to any organs in the body, at least as long one does not exceed the recommended dose.
Gabapentin to treat numbness, tingling and nerve pain (neuropathic pain)
Below you will find a summary about a medication used very often in the medical field to treat a variety of pain conditions- gabapentin, but with information specific to treating neuropathic pain in diabetes.
Please be aware that the article below is limited for informational purposes only. You should not consider it to be comprehensive or medical advice, since only a medical provider can assess your individual situation and safety of treatments in your individual case. Medicine is a constantly changing field, and you should consult your medical provider before applying any information below to your treatment. You may use the information below to learn more about the treatment, and as a basis to ask questions to your medical provider.
Introduction
Gabapentin was first introduced as a drug to control seizures in patients with epilepsy, and was often better known by the brand name NEURONTIN. It is now also available in the generic form which is usually inexpensive. It is officially approved by the Food and Drug Administration (FDA) to treat nerve pain from shingles (post-herpetic neuralgia), but over the years has become recognized and well accepted in the medical field as a medication to treat a variety of pain conditions including ‘nerve pain’ disorder like diabetic nerve pain (neuropathy), sciatica (radiculopathy), and even fibromyalgia.
How It Works
Although there has been extensive research on gabapentin, and it has been used as a medication for many years, the medical field does not know exactly how gabapentin works. The thought is that gabapentin relieves pain by altering the way the brain senses pain. In any case, many studies and a great deal of research has been done showing that gabapentin is effective in controlling pain, and reasonable safe for most people to use.
Possible Benefits
You may have heard that acetaminophen can cause permanent liver damage at higher doses. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, etc have been shown to cause damage to the stomach lining, affect the heart causing increased chance of heart attacks, and increase the chance of strokes. One of the main benefits of gabapentin is that it is unlikely to cause any serious injury to any organs in the body, at least as long one does not exceed the maximum recommended dose.
Gabapentin is not intended to be used as an ‘as needed’ pain medication. It is recommended to be taken on a daily basis, for maximum effect. This way, it keep the pain under steady level of control.
How It Is Used
Typically, gabapentin is most effective when taken three times daily, but often doctors and patients will adjust the medication based on each person’s individual condition and preferences, to either twice daily or sometimes even just once daily. Gabapentin is usually started at a dose of either 100mg or 300mg pills, and slowly increased over a period of days or weeks, to the intended dose.
It is important to know that usually you will NOT start noticing reduction in pain right away after starting gabapentin. It usually takes days or weeks for gabapentin to have its beneficial effect and for you to start noticing improvement in your pain. So it is best to stick with the medication and not discontinue it without checking with your medical provider if you have side-effects.
Possible Side-effects, Risks, Precautions
That brings us to a discussion about the possible side-effects of gabapentin. As mentioned above, gabapentin is a safe medication in that it rarely has any organ-damaging side-effects like acetaminophen or NSAIDs. But like all medications, there are some side-effects that can be bothersome enough that some people are forced to discontinue gabapentin. Keep in mind that not everyone experiences side-effects, and you may not experience any problem at all. However, it is important to be aware of the possible side-effects. Some of the common initial side-effects are drowsiness and tiredness. This may be just temporary when starting gabapentin, and often goes away within a few days of being on gabapentin, but can occur every time an increase is made in the dose of gabapentin. Dizziness is another possible side-effect but again, does not affect everyone, only some people. You and your medical provider should monitor for any serious negative change in your mood, especially if you have have a mood disorder like Bipolar disorder. Gabapentin does cause weight gain in some people. There is also the possibility of some swelling of the feet, lower legs, or hands. If you are unsteady or your feet, then please be extra cautious as gabapentin can worsen unsteadiness. Be aware that if you are on other medications that can cause drowsiness or dizziness or consume alcohol, then adding gabapentin could possibly make you feel more drowsy or dizzy. If you notice drowsiness or dizziness, please do not drive. People with kidney disease need a lower dose of gabapentin, and will have special dose instructions from their medical provider.
For a complete list of all possible side-effects, please click on the link below under ‘Additional Resources’, and consult your medical provider.
Conclusion
Gabapentin has undergone extensive research and has been used for many years to treat people for a variety of pain disorders including diabetic nerve pain (neuropathy) and other nerve pain disorders like shingles pain (post-herpetic neuralgia), and fibromyalgia. It is generally a safe medication that is tolerated well by many people. But like most medications, there is the potential for side-effects. Some side-effects are tolerable, and the benefits outweigh the risks. But for some people, the side-effects are bothersome enough or serious enough to warrant discontinuing the medication. If gabapentin has not been offered to you for your pain, then this would be a good starting point for a discussion about gabapentin with your medical provider.
Additional Resources
For a detailed description description of gabapentin for patients, you may visit this resource from the U.S. National Library of Medicine by copying and pasting this link in your web browser: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000940/
(Neurontin, Tylenol are Trade/Brand names copyrighted by the pharmaceutical companies that manufacture these medications)
General We know your time is valuable. We understand that if you are visiting this website, chances are that you are in pain. Or may be you are concerned about your own or your loved one’s medical condition- diabetes and its potential serious effects on our feet. We want to provide you with the highest quality information about everything related to diabetic foot pain, diabetic neuropathy and nerve pain, and other causes of foot pain. There is a great deal of information about these diabetes topics on the internet, but it is either incomplete, inaccurate, difficult to understand or just scattered over various different websites. We wanted to create a website which would be a ‘one stop resource’ for all topics related to effects of diabetes on the feet. Notice the larger than usual font used on this website? We specifically have a larger font on this website to make it easier for people with diabetic retinopathy and other eye issues to be able to read the content. We are very excited about being able to provide this service, and hope you will find it very useful to understand, prevent or treat these complications from diabetes.
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