Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. It is a serious and common diabetes complication that may affect up to half of all people with diabetes. This nerve damage is a potential complication from having high blood sugar levels for an extended period of time. The condition can develop slowly, usually within the first 10 years after a diabetes diagnosis. The risk of developing neuropathy increases the longer you have diabetes.
Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in the extremities, including legs, feet and hands. It can also affect the digestive system, urinary tract, blood vessels and heart. Some people experience only mild symptoms. But for many, diabetic neuropathy can be very painful and disabling.
The term neuropathy is used to describe several different types of nerve damage. In people with diabetes, there are four main types of neuropathy.
Peripheral Neuropathy
Peripheral neuropathy is a type of nerve damage that typically affects the feet and legs and can also affect the hands and arms. It is a very common type of neuropathy – about one-third to one-half of people with diabetes have peripheral neuropathy.
Focal Neuropathies
Focal neuropathies are conditions in which you typically have damage to a single nerve, most often in your hand, head, torso, or leg.
Autonomic Nerve Damage
Autonomic nerve damage affects your heart, bladder, stomach, intestines, sex organs, or eyes.
Proximal Nerve Damage
Proximal nerve damage affects nerves in the thighs, hips, buttocks, or legs. It can also affect the stomach and chest area.
Treatment
Diabetic neuropathy has long been treated with a variety of drugs, but the use of these medications is waning due to side effects, risk of dependency, and lackluster results, leaving millions of people with few treatment alternatives. Spinal cord stimulation, or SCS, is a well established approach to managing chronic pain that has been used for decades to treat back and leg pain. However, until recently, it had not been well studied for treating neuropathy of the feet caused by diabetes.
After a recent study, the FDA approved the use of spinal cord stimulation to treat diabetic neuropathy pain. The study showed that spinal cord stimulation eliminated neuropathy pain, and also helped restore foot sensation. “While we were primarily looking for improvement in pain and discomfort, many patients regained sensation in their feet for the first time in years…” Dr. Nandan Lad, one of the study physicians said. “And when patients can feel their feet, they’re less likely to experience some of the other complications of diabetes like immobility and foot injuries, ulcers, and amputation.”
You can think of a spinal cord stimulator almost like a pacemaker for diabetic neuropathy pain. It consists of a small pulse generator that is implanted under your skin, and two small wire leads that are placed near specific nerves along your spine. These work together to block nerve pain by stimulating the nerves in the area where you are feeling pain. The electrical pulses modify and mask the pain signal, preventing it from reaching your brain.
Spinal cord stimulators require two procedures to test and implant the device: the trial and the implantation.
Spinal Cord Stimulator Trial
The first step is a trial period. Your surgeon will place a temporary device for you to test out. This trial procedure is typically performed without any incisions and is similar to receiving an epidural injection. The generator/battery will be outside the body, typically on a belt, you’ll wear around your waist.
You will evaluate how well the device reduces your pain over about a week. The trial is considered a success if you experience reduction in pain of at least 50%.
If the trial is unsuccessful, the wires can easily be removed in the clinic without damage to the spinal cord or nerves. If successful, surgery will be scheduled to permanently implant the device.
Spinal Cord Stimulator Implantation
During the permanent implantation procedure, the generator is placed underneath the skin and the trial electrodes are replaced with sterile electrodes. Unlike the trial electrodes, these will be anchored to minimize movement. The implantation can take about 1-2 hours and is typically performed as an outpatient procedure.
Diabetic Neuropathy can be an extremely painful condition for many people with diabetes. If you are experiencing pain, numbness, tingling, burning, or other discomfort in your feet and legs from diabetic neuropathy, and medications haven’t given you adequate relief, talk to your physician about referring you to a Pain Management doctor like Dr. Smith for spinal cord stimulation.