It is estimated that 425 million people worldwide have diabetes, making it the largest global epidemic of the 21st century. More than 30 million people in the United States have diabetes and another 85 million in the United States have pre-diabetes. This number continues to increase at an unsustainable rate. Among the complications of diabetes is neuropathy.
This condition is caused by focal nervous system damage and diabetic neuropathy occurs in up to half of all individuals with diabetes. Diabetic neuropathy is a highly prevalent condition that substantially affects patients by increasing falls, causing pain and reducing quality of life. The annual cost of diabetic neuropathy and its complications is more than $10 billion in the United States. Approximately 30% to 50% of patients with diabetic neuropathy develop neuropathic pain, which most commonly takes the form of spontaneous burning pain in the feet. Over time, at least 50% of individuals with diabetes develop diabetic neuropathy. Glucose control effectively halts the progression of diabetic neuropathy in patients with type 1 diabetes, but the effects are more modest in patients with type 2 diabetes. Exercise is emerging as a promising prevention strategy in diabetic neuropathy.
The symptoms of diabetic neuropathy are numbness, tingling, pain and weakness and unsteadiness, starting distally (at the toes) and spreading proximally and then to the fingers when the lower-limb symptoms reach the knees. The optimal therapeutic approach includes lifestyle interventions, specifically diet and exercise, coupled with optimal lipid and blood pressure control to manage neuropathic pain.
In our world of modern medicine, diabetic neuropathy has no known cure. The goals of treatment are to slow progression of the disease, relieve pain, manage complications and restore function. Many prescription medications are available for diabetes-related nerve pain, but they don’t work for everyone. When considering any medication, talk to your doctor about the benefits and possible adverse events to find what might work best for you.
Pain-relieving prescription treatments may include:
- Anti-seizure drugs. Some medications used to treat seizure disorders (epilepsy) are also used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica®). Gabapentin (Gralise®, Neurontin®) is also an option. Adverse events may include drowsiness, dizziness and swelling.
- Some antidepressants ease nerve pain, even if you aren’t depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Drugs in this class include amitriptyline, desipramine (Norpramin®) and imipramine (Tofranil®). Adverse events can be bothersome and include dry mouth and drowsiness.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that may help with nerve pain and have fewer adverse events. The American Diabetes Association recommends duloxetine (Cymbalta®) as a first treatment. Another that may be used is venlafaxine (Effexor® XR). Possible adverse events include nausea, sleepiness, dizziness, decreased appetite and constipation.
- Sometimes an antidepressant may be combined with an anti-seizure drug. These drugs can also be used with pain-relieving medication, such as an over-the-counter medication including acetaminophen (Tylenol®, others) or ibuprofen (Advil®, Motrin® IB, others) or a skin patch with lidocaine (a numbing substance).
But please understand these pharmaceutical options do not treat the neuropathy, but rather treat the pain caused by the condition.
Is it possible to reverse neuropathy?
One unique treatment for neuropathy is the ReBuilder®, a prescription device that can calm down your overactive nerves and wake up your underactive nerves. In addition, the ReBuilder’s healing signals include electronic muscle stimulation, which automatically strengthens nearby calf muscles (or arm muscles when used for hand pain) and increases local blood flow to enhance permanent healing. Unlike pharmaceutical drugs or TENS devices that simply numb your nerves, Rebuilder supports and strengthens the nerves.
We discussed the Rebuilder with Dr. Josiah Fitzsimmons of West Des Moines, Iowa. Dr Fitzsimmons is a DC and is board-certified in neuropathy. He sees many patients on a regular basis, some traveling several hours for treatment. His clinic offers a 4-part process for the treatment of peripheral neuropathy. Number 1 is the ReBuilder. They also use a low-level light therapy device to help stimulate the growth/regrowth of the arteries through the process called angiogenesis. And then they have a supplemental and nutritional protocol in which 4 different supplements are prescribed to help improve blood flow circulation, as well as decrease inflammation throughout the body. And finally, a better diet protocol, similar to a paleo diet. We really try to put people’s bodies into an anti-inflammatory state. And then we also use our in-office services where we work directly with their nerves with neurology-based care.
And how long before a patient will see some results? Based on when they come in, we actually classify everybody’s body based on what overall phase they’re in. And based on that, we give them an expectation for how long it’s going to take to get to maximum correction. We really explain it is very similar to wearing braces on your teeth: some people wear them for 1 year or 2 years, 3 years, 4 years. Based on the level of degeneration that they’re in, it’s going to take a longer overall amount of time to get improvement, but typically people start noticing improvements within the first few months and then the full maximum amount of improvement typically can take upwards of 18 to 24 months.