Exploring Diabetic Neuropathy
By Dr. Richard Jacoby
Diabetic neuropathy (nerve damage) is a common complication of diabetes. About 60 to 70 percent of people with diabetes have some form of neuropathy. Some people have no symptoms, but others may experience pain, tingling, burning, or numbness (loss of feeling) in the hands, arms, feet, and legs. Neuropathy can also slow the healing process and stop patients from feeling the warning signs caused by foot injuries. Diabetic patients should check their feet daily for cuts, sores, swelling, and infection that could lead to amputation if left untreated.
We have found that neuroma pain (tumors of the nerve tissue) can be one of the first indicators that a patient is becoming diabetic. If this can be detected early in the pre-diabetic state, we can take measures to prevent diabetes. We work to identify the warning signs of diabetes early, and advise our patients in how to maintain proper foot care, decrease the effects of diabetic neuropathy, and avoid unnecessary limb amputation.
Our consultations begin with a thorough physical exam and medical history. We get to know our patients and their problems, and specific medical history knowledge helps us narrow the source of their suffering and relate it to other medical issues. Diagnostic techniques include the Pressure Specified Sensory Device (PSSD), an effective, pain-free method of testing the lower extremity for sensory deficits.
Compression in and around the nerves doesn’t have to hinder the lives of diabetic patients. We focus our treatments on regaining health in the entire body. We start conservatively with improved diet and exercise plans to control blood sugar, taking steps to reduce stress and ensuring patients are getting enough sleep. Medications, regional nerve blocks, and laser therapy can be helpful measures for controlling pain.
If conservative treatment methods are not effective, the highly specialized Dellon Decompression technique is a preferred surgical option. In the past, neuropathy was approached as a painful disease state for which symptoms could only be masked, but could rarely be cured. Some doctors subscribe to the theory that the nerve dies from the effects of neuropathy, and that the only treatment is to mask the pain and live with the disease.
We now know that the nerve is not dead, but has poor conducting abilities, similar to that of a short in electrical wiring. This is caused by compression around and within the nerves. This compression is much like that seen in carpal tunnel syndrome where the hands experience numbness, tingling and burning due to compress of the wrist nerve. In fact, if the compression continues long enough within the carpal tunnel, loss of muscular strength will also occur.
Dr. Lee A. Dellon, Professor of Neurosurgery & Plastic Surgery at Johns Hopkins, discovered that nerves in anatomically tight areas are subject to compression and swelling, causing neuropathy. The surgery decompresses the tunnels by making them bigger, restoring nerve function and decreasing the risk for ulceration and amputation. This surgical procedure can alleviate neuropathic pain, numbness, and muscular disorders in 80 percent of patients—both diabetic and non-diabetic.
For patients who don’t respond to conservative treatments and want to avoid surgical options, laser therapy is emerging as a convenient, pain-free choice. Deep tissue laser treatments can dramatically reduce neuropathy pain with no hassle, no drugs, and no side effects. Laser light therapy offers the most technologically advanced lasers currently available. These lasers penetrate deep into the tissue, stimulating cellular activity and increasing blood flow to “wake up” the affected nerves. They flood the tissues with photons, energizing damaged cells and increasing circulation to the painful area. This increases production of ATP (adenosine-triphosphate), producing a cascade of healing responses in the body to relieve pain, reduce inflammation, and accelerate tissue healing time. The laser relieves pain associated with joint, muscle, circulatory and inflammatory conditions, from everyday soreness to serious injuries.
There is no discomfort during treatment. Patients feel a deep, soothing warmth as the laser reaches the tissues that are causing pain. This pleasant, reassuring sensation means the laser is stimulating cellular activity. Patient treatments take 10–12 minutes, there are no known side effects, and results can be immediate.