Diabetic Neuropathy Symptoms|Symptoms of Diabetic Neuropathy

Diabetic Neuropathy

What is diabetic neuropathy?

Neuropathy is damage to nerves that causes pain, numbness and/or tingling. While, technically, many conditions are a form of neuropathy, most people tend to think of peripheral neuropathy when using the term ‘neuropathy.’ 


Peripheral neuropathy is nerve damage in the peripheral nerves. It usually starts in the hands or feet as numbness or tingling. Over time, these symptoms can progress to pain. Patients most often describe the pain as a burning type of pain.  


The most common cause of peripheral neuropathy in the hands or feet is diabetes. It is then commonly referred to as ‘diabetic neuropathy.’


Diabetes is a disorder of excessively high blood sugar levels in the body. It occurs when the body does not produce enough insulin, which is a hormone that controls blood sugar. Sometimes, the cause is due to the body not responding well enough to the insulin that is produced. Either way, when blood sugars remain high for a long enough period of time, changes to the nerve cells occur and leads to neuropathy.


There are two types of diabetes, which can typically lead to neuropathy. The first type is called ‘type I.’  It refers to a kind of diabetes that is typically diagnosed in childhood. Its cause is unknown. The second type of diabetes is usually diagnosed in adulthood. Its cause is chiefly related to obesity.  


Is there a cure for diabetic neuropathy?

Therapy for diabetic neuropathy involves aggressive treatment of diabetes. Treatment consists of medications to control blood sugars, dietary changes, exercise, and weight loss. Conventional wisdom is that if the diabetes is controlled early, the neuropathy can be reversed. However, diabetic neuropathy is often permanent when treatment for the diabetes is unsuccessful.


For the pain of diabetic neuropathy, goals of treatment are to reduce pain and improve functioning (i.e., the ability to do more life activities, like work).


Therapies & procedures for diabetic neuropathy

Common symptom management therapies include antidepressant medications, anticonvulsant medications, opioid medications, mild aerobic exercise, cognitive behavioral therapy, and chronic pain rehabilitation programs.


Antidepressant medications

Because some antidepressants are heavily advertised for use in diabetic neuropathy, patients are commonly familiar with them. When considering their use, it is important to understand the types of antidepressants and their relative effectiveness.  


Roughly, there are three types of antidepressant medications. Serotonin norepinephrine reuptake inhibitors (SNRI’s) are the newest type of antidepressant medications. SNRI’s are typically the ones that are advertised for use in diabetic neuropathy. Selective serotonin reuptake inhibitors (SSRI’s) are the second type and are a little older. They were originally developed for use in depression. They are now sometimes also used for diabetic neuropathy. Tricyclic antidepressants are the third type. They are the oldest type of antidepressants. They too were originally developed for use in depression. However, they also have a long history of use for diabetic neuropathy and other chronic pain disorders.  


Surprisingly, the newest type of antidepressant medications, the SNRI’s, are not the most effective. Wong, M., Chung, J. W., & Wong, T. K. (2007). Effects of treatments for symptoms of painful diabetic neuropathy: A systematic review. British Medical Journal, 335, 87. doi:  10.1136/bmj.39213.565972.AE The most effective type of antidepressant are the tricyclics. These are the oldest type. They are very likely to reduce pain by at least 50%.  


The SSRI’s, the second oldest type of antidepressants, are somewhat likely to reduce pain by at least 50%.


The SNRI’s, the newest type of antidepressants – and the ones that are advertised on television and in magazines -- are the least likely to reduce pain by at least 50%.


Anticonvulsant medications

Anticonvulsant medications are medications that were originally developed for the management of seizures. However, they have also been shown to be helpful in managing the pain of diabetic neuropathy.  


Tricyclic antidepressants and anticonvulsants are largely equally effective in reducing pain. Chou, R., Carson, S., & Chan, B. K. (2009). Gabapentin versus tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia: Discrepancies between direct and indirect meta-analyses of randomized controlled trials. Journal of General Internal Medicine, 24, 178-188. Collins, S. L., Moore, R. A., McQuay, H. J., & Wiffen, P. (2000). Antidepressants and anticonvulsants for diabetic neuropathy and post-herpetic neuralgia: A quantitative systematic review. Journal of Pain and Symptom Management, 20, 449-458.


Opioid medications

Opioid, or narcotic, pain medications are commonly used in clinical practice. However, there are few research studies that support their use for diabetic neuropathy.  


Gimbel, et al., Gimbel, J. S., Richards, P., & Portenoy, R. K. (2003). Controlled-release oxycodone for pain in diabetic neuropathy: A randomized controlled trial. Neurology, 60, 927-934. showed that the use of opioid medications was statistically better than placebo, but the actual clinical difference was minimal. Those who were treated with an opioid rated their pain on average at a 4 out of 10 whereas those who were treated with a placebo rated their pain at a 5 out of 10.


In a much smaller trial, Watson, et al., Watson, C. P., Moulin, D., Watt-Watson, J., Gordon, A., & Eisenhoffer, J. (2003). Controlled-release oxycodone relieves neuropathic pain: A randomized controlled trial in painful diabetic neuropathy. Pain, 105, 71-78. also found a minimally better response.


Mild aerobic exercise

Mild aerobic exercise, such as walking, bicycling, or pool exercises, are an important part of self-managing diabetes. Diabetes, of course, is one of the most common causes of neuropathy. It helps with maintaining blood sugar levels as well as weight loss. It is also helpful in managing the pain of diabetic neuropathy. The American Diabetes Association recommends obtaining at least 150 minutes of aerobic exercise each week. Sigal, R. J., Kenny, G. P., Wasserman, D. H., Castaneda-Sceppa, C., & White, R. D. (2006). Physical activity/exercise and type 2 diabetes. Diabetes Care, 29, 1433-1438. Balducci, et al., Balducci, S., Iacobellis, G., Parisi, L., Di Biase, N., Calandriello, E., Leonetti, F., & Fallucca, F. (2006). Exercise training can modify the natural history of diabetic peripheral neuropathy. Journal of Diabetes and its Complications, 20, 216-223. showed that mild aerobic exercise is able to reduce the likelihood of developing neuropathy due to diabetes.


Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a standard and effective treatment for chronic pain syndromes in general. Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain, excluding headache. Pain, 80, 1-13. While there are no controlled trials of CBT for diabetic neuropathy, it is commonly pursued on the assumption that it is effective, based on its demonstrated effectiveness for other pain conditions.  


Chronic pain rehabilitation programs

Chronic pain rehabilitation programs are interdisciplinary programs designed to help patients learn to self-manage chronic pain. Their goals are to reduce pain, reduce secondary problems associated with living with chronic pain, reduce the use of narcotic medications, and return to work or some other meaningful regular activity. They are effective in achieving these goals, and there is high quality research evidence demonstrating their effectiveness. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793. However, there are no clinical trials assessing the effectiveness of chronic pain rehabilitation programs solely for neuropathy.



Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain. The Institute for Chronic Pain is an educational and public policy think tank. Its purpose is to bring together thought leaders from around the world in the field of chronic pain rehabilitation and provide academic-quality information that is also approachable to all the stakeholders in the field: patients, their families, generalist healthcare providers, third party payers, and public policy analysts. Its aim is to change the culture of how chronic pain is managed through education and consultation efforts that advocate for the use of empirically supported conceptualizations and treatments of chronic pain. He also blogs at the Institute for Chronic Pain Blog.



Last Updated on Friday, 23 October 2015 15:44

Published on Friday, 27 April 2012 13:40

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