Neuropathy: Treatment & Prevention Principles
Written by Carolien Koreneff, CDE-RN, FADEA
As a health professional seeing a patient with neuropathy is not uncommon. This is because neuropathy is one of the more frequently occurring complications of diabetes. In actual fact between 60-70% of people with diabetes have some level of neuropathy. In this article Credentialled Diabetes Education, Carolien Koreneff talks about neuropathy diagnosis, treatment and prevention principles. Find helpful information and resources on neuropathy that you as a health professional can share with your patients.
What is peripheral neuropathy (PN)?
Peripheral neuropathy (PN) is caused by damage to the nerves in the periphery regions of the body, such as the hands and feet. The nerves in the feet are furthest from the brain and the spinal cord. As a result the feet are often the first place patients experience problems. Damage to the peripheral nerves can interfere with a person’s ability to feel pain.
There are two types of PN: painless and painful. However, many people experience both types at the same time.
Painless neuropathy includes symptoms such as numbness, feeling like they are walking on cotton wool or a pillow. They do not feel injuries to their feet. As a result injuries, such as cuts, blisters or cracks in calluses, can go undetected. And in some cases, develop into significant health issues such as ulceration, osteomyelitis and gangrene.
Painful neuropathy is an over-sensitisation to pain. Symptoms include: burning, stabbing or shooting pains, pins and needles, and cramps. It is common for people to feel extreme pain from things that normally don’t cause pain, such as from socks or bed sheets lying across their feet at night.
PN can cause a loss of balance, coordination and increase trips and falls. As a result this can affect the person’s mobility, confidence and independence.
Diabetic Autonomic Neuropathy (DAN)
Diabetic Autonomic Neuropathy (DAN) is another form of neuropathy that can affect people with diabetes. DAN usually presents with other diabetes complications, such as peripheral neuropathy. It makes sense, that if the nerves in the legs are affected, the nerves around the abdomen are similarly be affected. DAN can occur on its own, or before other diabetes-related complications.
Risk factors for PN
As a health professional, risk factors that can contribute to form a diagnosis of neuropathy include:
- vitamin B deficiency
- kidney or liver disease
- certain drugs used in cancer treatments
The longer the person has diabetes, the more likely they are to develop PN.
How is peripheral neuropathy diagnosed?
A diagnosis of neuropathy is made through a detailed history of symptoms and a physical examination. This includes testing the level of feeling with simple instruments, such as a monofilament, tendon hammer or biothesiometer. A neurologist can organise nerve conduction tests if the diagnosis remains unclear.
Treatment and prevention principles for neuropathy
Peripheral neuropathy treatment
Underlying conditions, such as hyperglycaemia, hypertension and vitamin B deficiency, should be considered first. Alcohol and smoking are also risk factors for the development of PN, as a result, supporting the patient to stop smoking and reduce their alcohol intake is important.
Regular analgesia usually don’t work, but neuropathic pain agents may help. Opioids, such as tramadol or oxycodone, can lead to dependence and addiction and as a result, prescription of these medications usually only occurs when other treatments fail.
Medications such as gabapentin and pregabalin were originally developed to treat epilepsy. However they may relieve nerve pain; but side-effects can include drowsiness and dizziness.
Capsaicin cream, which contains a substance found in hot peppers, can provide some improvements in PN symptoms. Particularly for burning pain, but not all patients can tolerate the skin burning and irritation that can occur with this treatment.
Certain tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline help relieve pain by interfering with chemical processes in the brain and spinal cord that cause the person to feel pain.
The serotonin and norepinephrine reuptake inhibitor duloxetine and the extended-release antidepressant venlafaxine can also ease the pain of peripheral neuropathy caused by diabetes.
Peripheral neuropathy prevention
Regular visits to a podiatrist can help diagnose PN in earlier stages. This can slow the development of symptoms and prevent further complications.
Patients can obtain an EPC referral from their GP. The referral will allow patients to access up to five Medicare rebate visits per year to allied health professionals (including podiatrists) which will help reduce costs.
Further information on neuropathy treatment and prevention principles
Helpful information and resources on neuropathy treatment and prevention principles that you may like to share with your patients include:
- Looking After Your Feet Fact sheet
- Tips to Prevent Foot Complications
- Innovative treatments – Nevro HF10TM Spinal Cord Stimulation
- Additional Fact sheets