DIABETES & FOOT PAIN
Diabetic nerve damage to the
feet, sometimes called diabetic neuropathy, or more correctly,
diabetic distal symmetric sensory polyneuropathy, frequently causes people
with diabetes to lose sensation in their feet, which is usually describe
as "numbness." There's really not much available to help this loss of
sensation.
However, diabetic neuropathy
occasionally creates a severe burning pain, or other very unpleasant
sensations, that are extremely frustrating. The following treatment
program is suggested for painful diabetic neuropathy.
First of all . . .
Get your diabetes straightened
out as best you can! Aim to keep your blood sugar tests normal as often as
possible, and to get your glycosylated hemoglobin value into the normal
range. The blood sugar should ideally be about 100 before
meals, and 140 or 150 as the highest blood sugar that is ever seen. This
extremely tight control may require shots of insulin several times daily,
very careful attention to meal planning and frequent monitoring of your
blood sugar level, under the care of a knowledgeable physician specializing
in diabetes, working together with a nurse who is a Certified Diabetes
Educator. This seems to be the best way to help to treat the painful
feet.
Protecting your feet
Whether or not you have diabetic
neuropathy, there is a list of things to do to protect your feet
-
Be careful to protect your
feet from injury. Any minor injury may allow infection to set in, which
could lead to gangrene and amputation. This means wearing shoes at all
times.
-
Look at your feet (with your
eyes, or someone else can look if it's difficult for you to do):
every day! If new problems are seen, such as a blister or red
spot, telephone your doctor's office promptly for advice; stay off your
feet until you get other advice.
-
Break in new shoes slowly, so
that they don't accidentally cause blisters.
-
Keep several pairs of shoes at
work, or in the car, so you can rotate among them if your feet feel tired.
-
Every patient with neuropathy
resulting in anesthesia should be under the care of a podiatrist for
routine foot care, such as trimming nails and calluses. (In the U.S.,
Medicare will pay for this care every 60 days, if you have diabetes and
are covered by Medicare health insurance.)
-
And be sure the diagnosis is
correct! (There are several other conditions that can also cause
neuropathy). You should have an EMG/NCV study done, and some blood tests.
Ask your diabetes specialist or neurologist if your personal physician
isn't sure what to do.
What about pain medications?
Pain control with standard
pain-relief medications such as aspirin, ibuprofen, and acetaminophen may be
helpful in some cases. You should be on a regularly scheduled program of one
of these, taking the medication several times every day. Since these
medications do have side effects, discuss which one to use with your
personal physician.
Unfortunately, these medications
probably will not provide adequate relief, and some patients have had
narcotics prescribed for pain relief. We do not recommend the use of
narcotics to treat diabetic neuropathy under any circumstances:
diabetes control and "pain-blockers" can often control the pain.
"Pain-blockers"
Medications that block pain can
be very useful in the treatment of diabetic neuropathy. These medications
are not pain killers. They were originally developed for
the treatment of other conditions, and have been found to work occasionally
to relieve diabetic neuropathy. It will be necessary to try a medication
program with one of these "pain-blockers" for several months to find out if
it might be helpful for your pain. Needless to say, these medications have a
risk of side-effects, which should be discussed thoroughly with your
physician before starting a trial. There is no guarantee that any of the
"pain-blockers" will work, and they must be tried, and then decide whether
it helped enough to keep it going, or whether a second (or third) program
might be tried.
Pain-blocking medications
include:
-
antidepressant medications,
such as Elavil (amitriptyline), Prozac (fluoxetine), and others;
-
anti-seizure medications, such
as Dilantin (phenytoin), Tegretol (carbamazepine), and Neurontin
(gabapentin).
Skin Creams
A non-prescription pepper cream
for application onto painful skin is available. This medication has been
shown to give relief for painful diabetic neuropathy in some cases. It does
have side effects of a transient severe burning for a week or so, and it is
expensive.
