Pain management key to treatment of diabetic neuropathy

The central part is well-protected, like any governing body should be, and the peripheral part which performs the vital function of the army of a nation, is left to fend for itself. As a result, far more diseases affect the peripheral nervous system, but few people care about it, he explains.

Diabetes mostly affects the axons, and especially the sensory axons, he says while talking about diabetes and neuropathy.

“It is quite common for diabetic patients to suddenly develop a cross-eye; it is not uncommon for a patient to be identified with diabetes for the first time when he is referred to a neurologist for evaluation when he develops double vision due to inability to move one eye in a particular direction,” says Dr Garikapati.

“Most of such so-called cranial mono-neuropathies recover, but they forewarn a tendency to develop progressive diabetic neuropathies of other types. While diabetic neuropathy is at present untreatable, it can be slowed down considerably by adequate control of blood sugar.”

The diagnosis of neuropathy depends on the history and physical examination, and at times requires a special kind of test called the ‘Nerve Conduction study’ or ‘Electromyoneurography’ or ‘ENMG’ for short.

This test is done in a specially-equipped lab, usually attached to the Neurology OPD, and is a day-care procedure. It is not a painful procedure, though the test does involve minor electric stimuli, he adds.

He also says that the most problematic thing about diabetic neuropathy is that it is very painful and occasionally intolerably so. “Sometimes, the patient paradoxically does not have normal sensation but has spontaneously generated abnormal pain even in the absence of any stimulus, a situation referred to as hyperpathia. Or a normal, non-painful stimulus is felt like pain.”

The pain itself may be relieved partly or wholly by medications or non-pharmacological techniques; the underlying neuropathy may or may not be treatable, but the responsibility of adequately dealing with pain itself rests with the medical staff.

“For this the patient is sometimes asked to grade her pain using a standard scale. She is trained on this scale and then this scale is used on a daily basis to plan treatment,” he says.

Medicines used to relieve naturopathic pain are aimed at both short-term and mid-term pain relief; in the long-term, adequate control of diabetes is the only form of treatment which has been found to have any effect.

Pain is a very subjective complaint, and has a strong psychological element; it is not possible to physically experience another person’s pain, however much one may empathise with that person.

That is why care-givers get frustrated with such patients and may go through some psychological changes of their own, including paranoia and disbelief. It is part of a physician’s duty to handle this aspect of the problem in order to be able to help the patient and his family with the painful neuropathy, he adds.

Sometimes patients or their care-givers may have problems with attitudes or understanding about pain itself and this may interfere with management of the painful neuropathy; the physician has to deal with this tactfully, keeping in mind the socio-cultural and religious beliefs of the individual while helping him/her to deal with her painful condition.

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