Peripheral neuropathy is the nerve damage caused by diabetes and chronically high blood sugar. It leads to loss of sensation, numbness, pain in legs, feet or hand. It is considered as the most common complication of diabetes. It is a known fact that almost 60% to 70% people with diabetes are affected by peripheral neuropathy, but not all go through pain. This nerve damage in individuals is not certain. Studies have concluded that diabetic people can reduce the risk of developing nerve damage by controlling their blood sugar levels. High blood sugar is known to damage nerves in a patient’s extremities and also in other parts of the body. These damaged nerves are then unable to convey messages between the brain and other parts of the body.
Along with the multiple treatment options available for diabetic peripheral neuropathy, controlling blood sugar levels is the most recommended one by doctors. It keeps the pain from getting worse and improves health. For this purpose the doctor recommends taking insulin. Medications help in relieving pain, improving the quality of life and making it more comfortable. For some people, relief is right on the drugstore shelves. Skin creams or common pain relievers like NSAIDs (nonsteroidal anti-inflammatory drugs) may help. It mostly depends on the severity of the pain. Local anesthetic injections lidocaine can also help. A surgery of destroying the nerves or relieving nerve compression is recommended.
With present day spine surgery procedures, a microdiscectomy should, for most part, be possible with a minimum amount of horribleness (e.g. post-operative inconvenience) and a high level of success in easing lower back pain and additionally leg pain.
A microdiscectomy is a standout amongst the most negligibly intrusive methods that are possible to reduce pain related with nerve root aggravation. In this surgery, a small incision (e.g. 1 - 1 ½ inches) is inserted in the lower back, and the part of the herniation that is connected with the nerve root is hauled out. The objective is to ease indications related to the nerve root pressure. The surgery has a moderately high success rate - around 90-95% - in alleviating leg pain and additionally buttock pain. Frequently, there is instant pain relief and patients wake up after the surgery feeling relieved from the torment. In the event that neurological side effects had been experienced preceding surgery, it might take more time for the nerve to recuperate and the patient may keep on feeling some numbness or weakness, or any of their earlier indications, for a while or up to a year. For a few, the symptoms may enhance, however, it may never completely resolve.
At screening, the eligibility criteria for consideration in the study were pain associated with diabetic neuropathy in light of history, monofilament testing, biothesiometry, clinical examination, and Michigan Neuropathy Screening Instrument (MNSI). A pain score of no less than 40 mm on the 100 mm visual analogue scale (VAS) was included. Other incorporation criteria included, patients between 18 to 75 years, both male and female with HbA1C under 10 mg%, duration of diabetes going from 1 to 15 years, and diabetic neuropathy from 1 month to 5 years.
Exclusion criteria of the treatment involves patients with contraindications to the medications, those with hepatic, heart or renal failure, patients with established neuropathy because of different causes, patients who have undergone a lower limb amputation, patients who did not submit a written informed consent, and pregnant women.
There are various side effects of medications. These include stomach irritation, increase in the risk of heart attack and stroke. These also cause serious side effects like bleeding if a patient is consuming it for a long time. It is unlikely, but there is also a chance of liver damage and kidney failure.
Regular monitoring by a primary care physician is required for patients with diabetic neuropathy. Patients must be monitored every 3 weeks to 5 months to assess whether the therapy is useful to the patient or not. This is determined by analyzing whether there is decrease in the pain, nausea or vomiting and also to fend off medications for painful neuropathy. Objective measures related to improvement and functions must be taken on every visit. Patient’s feet must be assessed with tuning fork and monofilament on every visit. Glycemic (carbohydrates in food affecting blood glucose levels) control is also essential. A multifaceted care program with a multifactoral approach through a nephrologist, diabetes educator or a diabetologist is needed.
The nerves of the patient may regenerate at a rate of 1-2 mm per day after surgery. Approximately, it takes about 2 months to recover fully.
The surgical cost of the treatment of diabetic peripheral neuropathy ranges between Rs. 2,00,000 to Rs. 2,75,000. On the other hand, medicinal cost may vary between Rs. 1,000 to Rs. 5,000.
There are varied results for the surgical treatment method. There is no guarantee of them being permanent. The nervous system can be reinjured and would need another surgery.