Are your legs on fire? Burning, aching, tingling, cramping? Feels like a thousand ants are crawling all over them? It could be peripheral neuropathy (PN). This is a fairly common condition that affects hundreds of thousands of Americans every year. The nerves in your legs can go haywire for many reasons. One of the most common reasons is poorly controlled diabetes. Chronic high blood sugar is toxic to nerve fibers. Diabetes can also damage the small blood vessels that feed nutrients to your nerves. When the peripheral nerves in your legs sustain these injuries, they start sending out pain signals to your brain to alert you that something is wrong.
Dr. Wigley and I spoke about this subject recently. Dr. Wigley is a podiatrist based out of North Miami and he manages tons of patients with diabetic peripheral neuropathy. Check him out at www.wigleyfeet.com. We both agreed that management of PN is challenging. The first step in treating diabetic neuropathy is blood sugar control. Oftentimes tight glycemic control can reverse the symptoms of diabetic neuropathy, if caught early enough. In many cases, however, the neuropathy is advanced and cannot be managed with glucose control alone. The conservative approach involves oral medications, such as gabapentin or pregabalin. These medications are relatively safe, and can be titrated until the desired affect is reached. If these medications fail to elicit the desired effect, there are stronger medications that we can try. The stronger opioid medications are not without their risks, so we try to avoid them if possible.
Peripheral nerve stimulators (PNS) are a pretty cool treatment option. PNS involves implanting a wire near the affected nerve, and cancelling out the pain signals. These stimulators emit a signal which closes the gate, and prevents pain signals from traveling up to your brain. In some cases, we can even use a spinal cord stimulator (SCS) to cancel out these signals at the spinal nerve root level. Check out my SCS blog for more info. If you’re at the end of your rope, and the neuropathy is driving you crazy, give me a call so we can discuss some treatment options.
