Neuropathy: A real pain for diabetes sufferers

Painful diabetic neuropathy is a frequent complication of diabetes. It is caused by damage to nerves that can lead to symptoms of pain and unusual sensations. Given the alarming rise in the rates of diabetes, diabetic neuropathy has the potential to create a huge burden on the Australian community. Symptoms can be particularly disabling, increase your need for health care, and impact on your daily occupational and social activities. This article provides an overview of the scope of diabetes in Australia and the risk factors, symptoms, burden and treatment of painful diabetic neuropathy.

Background

Diabetes is a common medical condition in the Australian community. It is estimated that one in four Australians over the age of 25 years has diabetes or its precursor which is called impaired glucose metabolism (or pre-diabetes). Diabetes is a condition in which there is too much of a special sugar called glucose in the blood, caused by a deficiency of insulin or a reduced effect of the insulin produced by the body. Diabetes is a serious condition and may cause many long-term complications such as heart disease, stroke, impotence, blindness and amputation.

Unfortunately rates of diabetes are increasing at alarming rates in all age groups in Australia. It is predicted that prevalence rates among people over the age of 15 years will increase to 10.5% by the year 2016. An aging population, high rates of obesity and sedentary lifestyles are thought to be contributing factors.

Among the various complications of diabetes, neuropathy (nerve damage) has been identified as a common cause of morbidity and death for diabetic patients. Type 2 diabetes is more commonly associated with neuropathy and you are at greater risk of developing neuropathy if your diabetes is poorly controlled or if you have had it for a long time. Some studies have shown that up to a quarter of the diabetic patients suffer painful diabetic neuropathy.  

Characteristics of diabetic neuropathy

Diabetic neuropathy is a broad term encompassing a variety of different clinical conditions. You may notice signs such as pain, weakness, reduced sensation or altered sensations (such as increased sensitivity to pain or touch). The classic description of diabetic neuropathy is called a ‘glove and stocking anaesthesia’. This refers to altered sensation that first develops in the fingers and toes and slowly progresses to involve areas closer to the centre of the body. Poor sensation in the feet can lead to complications such as severe ulcers, infections and in extreme circumstances the need for amputation.

A different type of nerve defect includes the autonomic nervous system. Your autonomic nervous system controls your internal organs. When your autonomic nervous system is disrupted you may develop problems such as a sudden drop in blood pressure when standing, diarrhoea at night, loss of bladder control and sexual dysfunction in men.

Distal sensory polyneuropathy (DSPN) is the most common form of neuropathy and the most common cause of pain. In its early stages you may notice symptoms such as tingling, burning, prickling, shooting-pain, deep aching, pins and needles, tightness, or cold sensations in your feet at night. As the condition progresses and more nerve fibres are affected, you may experience loss of sensation, numbness, loss of coordination and even movement problems. The symptoms usually start in the extremities of your body and gradually progress towards the central parts of your body.

Burden

Painful diabetic neuropathy can severely interrupt your life. As symptoms often occur at night you may have trouble sleeping and develop problems with mood and concentration. Your overall quality of life may be reduced and you may have difficulty completing work and participating in social activities. Research has also shown that diabetic neuropathy sufferers access health services more frequently than patients without the condition.

Risk Factors

The incidence of neuropathy is directly related to your overall control of your blood sugars. Poor control of your blood sugars and long duration of diabetes are significant risk factors for neuropathic complications. Therefore it is essential you take your diabetes seriously and adhere to diet, lifestyle and medication regimes. Older patients and those with a family history are also at higher risk.

There are several other potentially modifiable risk factors for neuropathy including raised triglyceride level (fat in the blood), weight, smoking, poor diet, high blood pressure and damage to nerves or blood vessels. You can therefore try to reduce your risk by having a healthy diet, losing weight, ceasing smoking, increasing exercise, and ensuring all your other medical conditions are well controlled.

Treatment

Management of diabetic neuropathy requires a multi-disciplinary approach. Initially you will be educated about the risk factors listed above and be encouraged to keep your blood sugars under tight control. Your doctor will also suggest treatments for any other additional medical conditions you have. There are now several drug therapies available to help treat pain associated with diabetic neuropathy. Some of these are aimed at treating the underlying disorder but most are concentrated on controlling the symptoms.

Four main drug classes including antidepressants, gabapentinoids, opioid analgesics and topical anaesthetics have been proven effective in the treatment of this disorder. You should discuss with your doctor whether any of the above listed treatment options are suitable for you.

Research is still continuing into this field and further information is needed to determine the exact cause of the disorder and the best treatment regime. It is likely that more treatments will be developed to treat neuropathic pain in the future.