QUESTION
I read with interest your articles from your previous columns in the Argus. I am 61 year old female and a type 2 diabetic for about 10 years now.
I suffer from burning, aching feet and lower legs which is particularly bad when I lie down- in fact the sensation various between burning, tearing ,shooting , electric shock etc. I am able to wear different types of shoes and can walk long distances (thank God for that) – and the force of gravity! Being up and about eases the discomfort somewhat; but the daily pain doesn’t go away.
I have in the past (on two occasions) seen a vascular surgeon who told me the blood circulation/ pulses in my legs were normal and when I asked him what to do about the pain he suggested that I see a neurologist; which I did. After a lengthy discussion/consultation with the neurologist and a hefty bill ,I walked away with no plan of action. A physician once prescribed Lyrica capsules for the pain – this definitely did not ease the pain ; in fact it made me feel like a zombie – I had to discontinue the medication because it was not safe being on the road while being in a trance!
Do you have any thoughts on the matter? The last thing I want to be is careless when I am sure there should be some treatment or solution for my condition.

ANSWER
Let’s cut to the chase – the description you give sounds almost pathognomic of Neuropathic pain ( Nerve tissue pain). There are a multitude of factors that contribute to nerve pain including inherited causes, metabolic diseases like diabetes, toxins and even chronic medication has been implicated in many instances.
While I understand your frustration and debilitating condition, the truth is that it is not an easy condition to treat. Damage to nerve tissue can be viewed largely in two main groups. Disease effecting the jelly like insulating layer(myelin sheath) surrounding certain nerve cells or neurons, or a process effecting the nerve axon itself. In the brain for example , Multiple sclerosis is a well known demyelinating disease of the brain and spinal cord neurons. In your legs the most likely process leading to your pain is damage to the long peripheral nerves of the lower leg. Peripheral neuropathy can be extremely painful when the sensory fibers are involved.
Your best advice at this stage is excellent Diabetic control, regular exercise, aspirin as well as nutritional supplementation of B vitamins – especially B12. No alcohol.
Pain control is best achieved by drugs directed at altering the nerve conduction and pain thresholds – working on the cell receptors or ion channels which mediate electric impulse conduction. Anti-epileptic drugs work on the Sodium and Potassium channels too.
The best known treatments for diabetic sensory neuropathy include Amytriptilline, Carbamazepine, Gabapentin and even Phenytoin. Sodium Valproate has also been used but with variable results.
It is crucially important to note the pathophysiological mechanism of the disease – despite pulses all being present and palpable, the microvascular complications of Diabetes are silent killers. Optimal sugar control and excellent compliance with meds as well as lifestyle modification is the only hope of halting further damage. The degree to which existing damage to the nerve is reversible depends on the extent of damage, duration of disease as well as comorbid factors.

NERVE PAIN – IS THERE HOPE ?

Leave a Reply

Your email address will not be published. Required fields are marked *