The American Academy of Neurology (AAN) issued a new guideline yesterday on the most effective treatments for diabetic nerve pain, the burning or tingling pain in the hands and feet that affects millions of people with diabetes.
The recommendations of this guideline will serve as the foundation for a new set of tools the AAN is creating for doctors to measure the quality of care they provide people with nerve pain. The measures will be released in 2012.
The guideline ‒ published yesterday in the online issue of Neurology and presented at the American Academy of Neurology’s Annual Meeting in Honolulu ‒ was developed in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation.
Nerve pain is different from other types of pain, like pain from a muscle ache or sprained ankle. Common pain medicines like aspirin may not work for nerve pain. Nerve pain is unique and feels different than muscle pain. Since all pain is not the same and nerve pain treatment is different from muscle pain treatment, it’s important to understand the source of your pain.
Unfortunately, nerve pain can be one of the most intense pains that people feel. And Diabetic Nerve Pain can make normal daily activities more difficult.
When a person has pain that is caused by nerve damage from diabetes, it is simply called painful Diabetic Peripheral Neuropathy (pDPN). The most common cause of pDPN or Diabetic Nerve Pain is poorly controlled blood sugar levels. Over time, high blood sugar levels can result in nerve damage. Controlled blood sugar levels may help prevent, stabilize, and delay further nerve damage.
According to the guideline, strong evidence shows the seizure drug pregabalin (Lyrica) is effective in treating diabetic nerve pain and can improve quality of life; however, doctors should determine if it is appropriate for their patients on a case-by-case basis.
In addition, the guideline found that several other treatments are probably effective and should be considered, including the seizure drugs gabapentin (Gabarone) and valproate (Depacon), antidepressants such as venlafaxine (Effexor XR), duloxetine (Cymbalta) and amitriptyline (Elavil, Endep) and painkillers such as opioids and capsaicin. Transcutaneous electric nerve stimulation (TENS), a widely used pain therapy involving a portable device, was also found to be probably effective for treating diabetic nerve pain.
“We were pleased to see that so many of these pain treatments had high-quality studies that support their use,” said Vera Bril who is with the University of Toronto and a member of the AAN. “Still, it is important that more research be done to show how well these treatments can be tolerated over time since diabetic nerve pain is a chronic condition that affects a person’s quality of life and ability to function.”
To recap, the most common type of diabetic neuropathy is peripheral neuropathy (burning, throbbing, or painful tingling in your hands or feet). In the early stages of peripheral neuropathy, some people have no signs. Some may have numbness or tingling in the feet. Because nerve damage can occur over several years, these cases may go unnoticed. The patient may only become aware of neuropathy if the nerve damage gets worse and becomes painful.
It is estimated that diabetic nerve pain affects 16 percent of the more than 25 million people living with diabetes in the United States and is often unreported and more often untreated, with an estimated two out of five cases not receiving care.
According to one survey, about 50% of people with diabetes have some form of nerve damage known as diabetic neuropathy; 64% of Diabetic Nerve Pain sufferers report that their pain interferes with the daily activities that matter to them; 71% of sufferers say their pain interferes with the daily activities and makes it hard for them to fall asleep; 49% of diabetics had not had a discussion with their doctor about Diabetic Nerve Pain or its symptoms in the last 12 months and 65% say the pain decreases their general motivation.
In short, Diabetic Nerve Pain may make it hard to do what is needed to manage your diabetes. It can create a cycle where one problem just leads to another problem, which makes the first problem even worse. Pain may make it difficult to stay physically active and focus on other areas of diabetes care.
If you are not physically active and focusing on diabetes care, it may be hard to keep your blood sugar levels close to the normal range. In turn, if your blood sugar levels are raised for long periods of time (many months or years), you may be more likely to develop more health problems. This may include more nerve damage. Finally, people with Diabetic Nerve Pain also have more risk for symptoms of depression, which can further lower the drive to focus on the day-to-day parts of good diabetes care.
Most diabetic neuropathy is caused by peripheral artery disease, in which the small blood vessels are obstructed or partially obstructed and cannot carry oxygenated blood to areas of the body. These areas have pain or other difficulties due to the lack of oxygen. Diabetic Nerve Pain may make it hard to do what is needed to manage your diabetes. It can create a cycle where one problem just leads to another problem, which makes the first problem even worse.
With Diabetic Nerve Pain, decreasing your activity level is a problem, making it harder to manage your diabetes. (We all know it’s important to be physically active to keep your blood sugar level under control.) With nerve pain, your nerves repeatedly send extra electrical signals to the brain. These extra signals can cause pain when you do something that is not normally painful, e.g. putting on shoes. If this pain is not properly diagnosed and treated, it can cause difficulties with walking, working, or even being in social situations.
Over time, elevated blood sugar levels could potentially lead to different diabetes complications, like kidney and eye (retinopathy) conditions besides leading to nerve damage, especially in the feet. Therefore annual foot exams are crucial to check for diabetic peripheral neuropathy. Indeed, regular examinations are important because a diabetes patient can have peripheral neuropathy without pain, especially in the early stages of the neuropathy.
To be sure, Diabetic Nerve Pain care is an important part of overall diabetes care. And it is a part you may be able to actively improve. With less pain, you’ll feel better and may even increase your physical activity level. This is a key component of good diabetes care.
If you have Diabetic Nerve Pain, it’s very important to keep your blood sugar levels as close to the normal range as possible. This may help stabilize and prevent further nerve damage. It’s also important to keep your pain under control. Then you may be able to return to activities that are important to you.