Nerve Pain

DIABETIC NEUROPATHY

Peripheral neuropathy (or neuropathy for short), refers to damage to the nerves in the peripheral nervous system, which is the network of nerves that connects the brain and spinal cord to the rest of the body. The peripheral nervous system has three types of nerves: motor, autonomous and sensory. These nerves make it possible for you to do things like hear, see, feel, move and even breathe. If they get damaged, they stop working properly and can produce symptoms such as pain, numbness and tingling.

There are a number of factors that can cause neuropathy, such as autoimmune diseases, alcoholism, viral or bacterial infections, injury or other trauma, and diabetes. When neuropathy occurs as a result of diabetes, it is called diabetic neuropathy.

Diabetic neuropathy affects about 50% of diabetic patients1 and is most commonly caused by blood glucose levels being too high for an extended period of time. High sugar levels in the blood damage the capillaries (small blood vessels) that supply the nerves, and this prevents them from getting the nutrients they need to function.

DIABETIC NEUROPATHY SYMPTOMS

There are four main types of diabetic neuropathy – peripheral, autonomic, proximal (also called radiculoplexus) and focal (also called mononeuropathy). Patients can develop one of these or more than one.
Symptoms will vary depending on the type of diabetic neuropathy you have and the nerves that are affected.

• Diabetic peripheral neuropathy most commonly affects the feet and legs, and symptoms include pain, burning, numbness and tingling.
• Diabetic autonomic neuropathy affects the nerves that control body functions, so symptoms can include sexual dysfunction, urinary incontinence, diarrhea and constipation.
• Diabetic proximal neuropathy affects the thighs, hips and buttocks and can cause weakness in the legs.
• Diabetic focal neuropathy affects nerves in the head, torso and leg. It can cause eye pain, double-vision, chest pain, abdominal pain, and even paralysis on one side of the face.

DIABETIC NEUROPATHY DIAGNOSIS & TREATMENT

Diabetic neuropathy may be diagnosed with a complete medical history and a thorough physical exam. During the exam, the doctor will ask about your symptoms and may check things like your reflexes, muscle strength, and sensitivity to temperature and touch. Other tests may also be conducted to confirm your doctor’s diagnosis and/or determine the cause of the condition. Examples of these tests include: filament test, nerve conduction study, electromyography (EMG), quantitative sensory testing, and autonomic testing.

There is no cure for diabetic neuropathy, but symptoms can be managed with proper treatment. The main goal of treatment is to slow the disease’s progression, relieve pain, manage complications, and restore lost function. Keeping your blood glucose levels under control plays an important role.

For pain relief, your doctor may recommend things such as nonsteroidal anti-inflammatory drugs, anti-seizure medications, antidepressants, neuropathic pain medications, membrane stabilizing medications, or opioid analgesics. Spinal cord stimulation may also be used to decrease diabetic neuropathy-related pain.

To learn more about therapies used to relieve pain associated with diabetic neuropathy, contact us to schedule a consult with a pain management expert. We have years of experience treating diabetic patients and are constantly learning about innovative pain relief treatments to help you get back to your normal self.

REFLEX SYMPATHETIC DYSTROPHY / COMPLEX REGIONAL PAIN SYNDROME

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by severe pain, swelling, and changes in the skin, such as the pigmentation and/or texture. Previously known as reflex sympathetic dystrophy (RSD), CRPS most commonly develops in an arm or a leg, typically after surgery or as a result of an injury (i.e. a broken bone or sprain); and it may subsequently spread throughout the body.
Other events or conditions that can trigger CRPS include: brain diseases, such as stroke; degenerative arthritis of the neck; and heart disease. Though more uncommon, patients may also experience CRPS without being able to identify the event or injury that triggered it.
There are two types of complex regional pain syndrome:

• Type 1: Without nerve injury. Most patients are diagnosed with this type.
• Type 2 (formerly known as causalgia): With nerve injury. This type of CRPS tends to be more painful and is characterized by burning pain.

SYMPTOMS OF CRPS/RSD

The pain associated with complex regional pain syndrome is often more severe than what is customary for the initial injury. Symptoms can start out mild or moderate and get worse over time, either gradually or quickly, depending on the patient. The first signs of CRPS are usually pain in the affected arm or leg, redness, swelling, and sensitivity to touch and cold.
Other symptoms of complex regional pain syndrome include:

• Burning or throbbing pain in the limbs
• Changes in skin temperature, alternating between sweaty and cold
• Changes in skin texture (shiny or dry) and/or color (white, blotchy, red or blue)
• Stiffness in the joints
• Muscle spasms, weakness, and muscle loss
• Loss of movement in the affected arm or leg

Symptoms may last for a few months to several years – and they can get progressively worse.

DIAGNOSIS & TREATMENT

Your doctor will diagnose complex regional pain syndrome based on a physical exam and medical history. The following tests and procedures may also be used to help make a CRPS diagnosis: bone scan to help detect changes in bone density; X-ray to check for loss of minerals in the bones; magnetic resonance imaging (MRI) to identify tissues changes; thermography to measure skin temperature and blood flow; and other sympathetic nervous system tests.
It is possible to recover fully from CRPS if you start treatment early (within months of your first symptoms). At Paradigm Pain and Spine, we tailor treatment plans to meet the individual needs of each patient. Treatment options may include:

• Pain relievers (over-the-counter and/or opioid)
• Topical analgesics
• Physical therapy
• Spinal cord stimulation
• Sympathetic block
• Stellate ganglion block
• Intrathecal drug pumps
• Transcutaneous electrical nerve stimulation
• Other medication (corticosteroids, alpha-blocking drugs, calcium channel blockers)

If you think you might have complex regional pain syndrome (reflex sympathetic dystrophy), contact us to make an appointment with a pain specialist. The earlier you start treatment the more likely it is to be effective.