Pain conditions due to Diabetes | Sunday Observer

Pain conditions due to Diabetes

21 March, 2021

Patients can develop pain in the following forms in relation to diabetes.

1 Diabetic nerve pain

2 Generalised body aches and pain

3 Pain due to the diabetic ulcers

4 Phantom limb and stump pain following amputations

Diabetic nerve pain

Diabetic nerve pain is a syndrome that affects people with diabetes, worldwide. It can appear in people with insulin dependent type 1 or maturity onset type 2, diabetes.

This is also known as, “diabetes peripheral neuropathy”. It is one of the most common neuropathic pain conditions.

Diabetic nerve pain commonly occurs when a person with diabetes has prolonged spells of high blood sugar levels. The high blood glucose affects the nerves by damaging the blood vessels which supply them.

Smoking and consumption of alcohol are also known to increase the risk of experiencing nerve pain.

Diabetic nerve pain usually occurs in peripheral regions or extremities, such as feet and legs or hands and arms.

Neuropathic foot pain is one out of a number of conditions affecting the feet which are termed as problems of ‘diabetic foot’. Sensations in the feet can be less which can lead to damaging the foot, leading to diabetic ulcers.

For this reason, people with diabetes are advised to undergo a foot examination once a year.

A foot exam can help in two ways. One way on which it can help is, by helping to diagnose new problems, such as diabetic neuropathy or circulation issues and it can also help to spot further complications of the foot such as wounds, blisters and a joint disorder known as Charcotarthropathy.

What are the symptoms of diabetic nerve pain?

Diabetic nerve pain symptoms can include:

  •  Prickling or tingling feelings
  •  A burning sensation
  •  Sharp, stabbing or shooting pains in the aforementioned areas.

These can range from mild to extreme. In serious cases the whole area may become numb.

A condition known as dysesthesia can develop, in some people, which affects one’s sense of touch causing a tingling or burning sensation and can cause sharp pain when touching objects and surfaces.

How does neuropathic pain affect people with diabetes?

Diabetic nerve pain unfortunately can be very dangerous for people with diabetes.

At an early stage it can impact day to day activities.

One of the dangers of diabetic neuropathy is, if it leads to a foot ulcer (wound), developing a level of high blood sugar and poor circulation can both mean the wound may take longer to heal and be more susceptible to infection, which may result in amputation.

If someone has diabetes and is concerned about diabetes nerve pain, contact a pain specialist to discuss the symptoms or take their advice.

Can diabetic nerve pain be treated?

People suffering from nerve pain will usually be encouraged to make changes to their lifestyle and or their diets, such as giving up or cutting down on alcohol or smoking, getting more exercise and receiving help with controlling their blood sugar levels.

The pain specialist may also offer treatments to reduce the symptoms of pain.

Medications for diabetic nerve pain

Medications which may be offered could include:

  • Amitriptyline
  •  Pregabalin
  •  Duloxetine
  •  Nortriptyline
  •  Imipramine
  •  Lidocaine
  • Tramadol
  •  Morphine
  • Fentanyl patches

Nerve blocks such as sympathetic Lumbar plexus block and radio frequency can help the neuropathic pain in the legs. These are carried out by pain specialists. In England I use to receive referrals from endocrinologists to manage patients’ diabetic neuropathy. But in Sri Lanka this is does not happen yet but I am sure things will improve once people become more aware about pain medicine. My challenge is to get the message across to the Sri Lankan public that no one should suffer with pain.

Generalised body aches and pain

This is a common problem amongst diabetics. This happens due to changes in the autonomic nervous system. This leads to extreme fatigability. The treatment is the same as any pain condition.

Pain due to a diabetic ulcer may be a distressing symptom. Generally the ulcers are painless due to the peripheral neuropathy as the nerves do not function well. But dressing or changing clothes can be a distressing and painful action. I prescribe 5% Lidocaine patches to be applied before and after the wound dressings.

Phantom Limb Pain is yet another pain condition linked to Diabetes which I hope to discuss in a separate article.

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