Diabetic peripheral neuropathy is a painful nerve condition that typically affects the hands and feet. Most often, it will affect the farthest areas of the extremities first than gradually work its way proximally towards the body. This causes pain in a "stocking and glove" distribution.
Treatment first and foremost is strict control of blood glucose through diet, exercise, and medication management if indicated. You should speak routinely with your primary care provider who will likely follow progress through blood work checking a Hemoglobin A1c. Additionally, it is suggested that you also seek consultation with a podiatrist on a routine basis for foot exams to ensure there are no sores or wounds which could worsen over time if not treated early.
Unfortunately, despite these efforts pain can sometimes persists. Options for pain relief at this point commonly falls to topical medications and oral medications to decrease the intensity of the burning or painful sensations. We are happy to review any medications you may be presently taking and discuss titration or alternative options.
Recently, the FDA has approved Spinal Cord Stimulation for the management of painful diabetic neuropathy. Such intervention offers the potential pain relief without having to take daily medications. See below to find out more.
Complex regional pain syndrome (CRPS) is a painful condition that often arises following trauma to the extremity or an orthopedic surgery. It was previously referred to as Reflex Sympathetic Dystrophy or Causalgia. Now it is subdivided into the following:
Regardless of Type 1 or 2, the symptoms are characterized by intense burning pain particularly in the setting of light touch or temperature changes. It can be affiliated with swelling, skin and hair growth changes, as well as alterations in motor function. The diagnosis is predicated on the fulfillment of the Budapest Criteria.
Treatment for both consists of physical and occupational therapy with a particular focus on rehab and desensitization therapy. Additionally, neuropathic pain medications can assist in decreasing pain symptoms. In severe pathology, the utilization of sympathetic blocks or Spinal Cord Stimulation can offer notable pain relief.
These are some of the commonly asked questions about this therapy option to help guide a more detailed conversation with your physician.
This is the use of a small medical device that is implanted underneath the skin into the epidural space to stop the pain signals that may be traveling from your hands and/or feet. The device is NOT placed directly into or onto the spinal cord rather is placed in the epidural space. It is important to recognize there are a variety of different devices produced by different companies that are available to patients. Each has their own benefits and draw backs. Coastal Pain and Spine Center is unique in that we offer all of the major devices to our patients compared to others that may exclusively use one company. Discuss which is best for you with your physician.
This procedure has a growing number of indications though classically it was utilized in the treatment of back and sciatic nerve pain. It later expanded as a treatment for CRPS. More recently, there has been FDA approval for the management of diabetic nerve pain. The therapy has shown great success in reduction of pain and decreased need for medication to treat pain.
The goal of stimulation is to interrupt the pain signals providing targeted long-lasting relief. This is completed through sterile implantation of a small catheter under the skin into the epidural space. In some respects the TRIAL is similar to a labor epidural (pregnancy) and epidural steroid injection (back pain treatment). A needle is placed under low dose x-ray guidance into the epidural space then a catheter which is referred to as a lead is carefully guided into place. The other end is taped to the skin after the needle is removed. The IMPLANT is more invasive requiring surgery with two small incisions approximately 1.5 inches each to allow the device to be placed under the skin entirely.
The stimulator TRIAL is the opportunity for patients to "test drive" the device before any implant. A TRIAL typically lasts for 5-7 days and is the opportunity for patients to determine if it helps with pain symptoms. During this time, one end of the catheter is in the epidural space and the other end secured externally to the skin with a sterile dressing and tape (similar to a labor epidural for pregnancy). At the end of the 5-7 days regardless of the outcome, the catheter is painlessly removed. ONLY if there is significant pain relief do patients go forward with the IMPLANT which requires surgery to place both the lead and a small battery underneath the skin.
As with any procedure there are risks of bleeding and infection. Please discuss with your treating physician if you are on any blood thinners or have any immunosuppressive disease or are taking antibiotics so they can mitigate these risks as much as possible Additionally, there is also a risks of nerve injury or damage with needle or lead placement both during the trial and implant though this is rare.