Nerve pains in Diabetes
Dr. Jitendra Singh
Of all the complications of Diabetes, peripheral neuropathy involving nerves causes greatest morbidity and compromises the quality of life. Muscle pains, muscle spasms, night cramps, numbness, dull aches, shooting or lightening pains, pins and needles sensation etc. Incidentally, there is tendency to overlook Diabetic neuropathy because it is more of a nuisance than a life-threat unlike other complications affecting kidneys, heart etc.
A senior official, working as a General Manager with a state Corporation, reported one day at this columnist’s clinic with the plea that he felt so incapacitated with his Diabetes that he wanted a doctor’s certificate to support his resignation letter to the authorities. After detailed probing, it was discovered that the gentleman was not suffering from any obvious physical incapacitation or disability as such. All that he had was Diabetic Neuropathy or diabetic affliction of nerves but so excruciating it was that it had driven him to a state of extreme depression and hopelessness.
Of all the complications of Diabetes, peripheral neuropathy involving nerves causes greatest morbidity and compromises the quality of life. Muscle pains, muscle spasms, night cramps, numbness, dull aches, shooting or lightening pains, pins and needles sensation etc. Incidentally, there is tendency to overlook Diabetic neuropathy because it is more of a nuisance than a life-threat unlike other complications affecting kidneys, heart etc.
Wide Variety of symptoms
Even though neuropathy in Diabetes has a wide range of spectrum described under different types of neuropathies ranging from peripheral neuropathy to autonomic neuropathy, this write-up focuses primarily on peripheral neuropathy which is more often outwardly manifest and also more often agonising.
Diabetics suffering from peripheral neuropathy complain of a variety of pain and altered sensations. The skin tingling sensation and burning sensation in the lower limbs is a common symptom. Sometimes, an individual complains of painful sensation even on contact with something like bed sheets during the night sleep. Diabetics with peripheral neuropathy are also at times known to experience abnormally exaggerated response to painful stimuli. Other symptoms like cramps, numbness etc have been described in the preceding paragraphs
Different Remedies Tried
The symptoms of diabetic peripheral neuropathy, as mentioned above, can vary from a mild discomfort to an incapacitating situation. Therefore, the management of this disorder poses a difficult challenge for the treating Diabetologist or physician
Although many remedies have been recommended, none have been consistently effective in all cases. Some drugs or medicines are found to be beneficial for certain individuals while not useful for others. However, strict control of Blood Sugar levels is the basic prerequisite before initiating any further treatment. Improvement in Blood Sugar levels has also been shown to decrease the pain though it may not improve the sensory nerve conduction.
Drug therapy is commonly used in conjunction with physical therapy. Several classes of drugs are tried, singly or in combination with varying success.
The rehabilitation of an individual suffering from diabetic neuropathy includes preventive measures, alteration of risk factors and modification of lifestyle. The common risk factors are advanced age, long duration of diabetes, poor control of Blood Sugar, high blood pressure, smoking, disturbed cholestrol or lipid levels and alcohol intake. One of the main rehabilitation goals is to educate the affected individual to sustain maximum functional levels of physical activity through optimum exercise maintenance of muscle mass as also muscle strength and to ensure proper nutrition to promote recovery from neuronal degeneration. Adequate care is also required to prevent avoidable contractures.
Other modalities like, for example, Transcutaneous Electrical Nerve Stimulation (TENS) are also tried whereever feasible.
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