Managing Neuropathy with Diabetes: Advanced Treatments

Diabetic polyneuropathy is a complication of diabetes that can worsen quality of life.

Diabetes is one of the most common diseases worldwide. According to the World Health Organization, more than 422 million people suffer from diabetes. Diabetic polyneuropathy (DPN, or often referred to as peripheral neuropathy or just neuropathy) is a complication of diabetes that can worsen quality of life.

DPN is the most common form of peripheral neuropathy. It is the result of nerve damage, primarily to small nerve fiber. This is a result of high blood sugars and poor blood flow related to diabetes and other metabolic problems such as high cholesterol. It most commonly starts with and affects the feet and often works its way up into the leg or hands. It can cause symptoms such as numbness, tingling, altered sensation to temperature and touch, and even loss of balance or coordination, which can lead to falls. Unfortunately, it very often progresses to frank pain that is often described as a burning sensation. The longer one has had diabetes, the more likely they are to experience painful neuropathy.

Treatment starts with good blood glucose control. Medications can be helpful in controlling symptoms, but many patients have intolerable side effects or simply do not achieve satisfactory pain relief with medications alone. Historically, there have not been great options beyond medication, and many patients continue to struggle with painful DPN. Fortunately, we now have an additional avenue to treat DPN. Spinal cord stimulation (SCS).

SCS is a therapy that delivers low levels of electricity to the spinal cord. The goal is to modulate or reduce pain signals. By using specialized electric waveforms, we can reduce the number of signals that increase pain and increase the number of signals that decrease pain, leading to better overall pain control.

Interestingly, the origins of SCS can be traced to ancient times. The Romans used torpedo fish, an eclectic fish, to alleviate pain. Fortunately, the technology has greatly improved since that time, but the basic concepts are the same. Electrical stimulation is used to calm the pain signals going from damaged nerves to our brain. In fact, SCS has been used for decades to treat persistent pain after back surgery, phantom limb pain, and “sciatica” type pain, amongst other ailments. SCS is FDA-approved specifically for painful diabetic neuropathy.

SCS is first done on a trial basis. This means patients can “test drive” the therapy and ensure it will help them. In a short outpatient procedure, we place tiny temporary electrodes into the spine and then use specialized electric waveforms to decrease the pain signals to the brain. The central part of the spinal cord plays a crucial role in pain transmission. That’s where the therapy is targeted. If the therapy is deemed successful, we can implant the electrodes in a similar outpatient setting.

Throughout the course of therapy, from trial to after implantation, patients will work with our team. They will develop personalized treatment programs that are tailored to an individual’s symptoms and pain control needs. As with any treatment, there are risks and benefits with SCS. But SCS represents a valuable, non-opioid, non-medication option or complementary treatment to fight painful diabetic neuropathy.

70-percent of patients who try SCS for painful DPN find meaningful pain relief. Patients also often report other improvements such as better sleep and improved mood. Studies also show that patients experience pain relief for many years after starting SCS therapy.

Your primary care provider can help decide if you are a candidate for this therapy. If you and your primary care provider think you could benefit from SCS for nerve pain, meeting with a board-certified interventional pain physician can be a good step towards improving quality of life.

 

Dr. JD Williams, MD specializes in Pain Management at Saint Alphonsus. To make an appointment, please call 208-367-2200.