How can peripheral neuropathy be treated successfully?
Nearly one-third of patients with diabetes develop neuropathy. The most common type of diabetic neuropathy is called distal symmetrical polyneuropathy (DSP). DSP typically affects the feet first and may involve the hands subsequently. The most common symptoms are paresthesias, often described as a “pins and needles” sensation, and loss of sensation. Loss of sensation is very dangerous. Without the ability to feel pain, one may not be aware of an injury and so would not tend to it. An example of this would be someone who steps on a nail which punctures the sole of their shoe, cutting their foot. They may continue to wear the shoe with the nail continuing to damage their foot until they see blood on their sock. The same person is at risk for impaired circulation from diabetes. A wound is less likely to heal when blood flow is inadequate. For these reasons, diabetes is the leading cause of non-traumatic amputations. In addition to paresthesias and loss of sensation, neuropathy can cause pain. The pain may be mild and little more than an inconvenience to the patient. In severe cases, the pain may be incapacitating. It is important to consider causes of neuropathy other than diabetes. These include vitamin B12 deficiency, which is more common among people taking metformin and is easily treated. It is also important to keep blood glucose levels well-controlled. This can slow the progression of neuropathy and may even lead to some improvement. Several different types of medications are used to treat neuropathic pain. These include tricyclic antidepressants, anticonvulsants, and narcotic pain medications. In 2011, the American Neurological Society published guidelines for the treatment of diabetic neuropathy. They found that the medication with the best evidence of benefit is pregabalin (Lyrica).