Neuromodulation Interventions for Diabetic Neuropathy

Neuromodulation Interventions for Diabetic Neuropathy

Diabetes is one of the most common health conditions in the United States with more than 34 million people who suffer from this disease. Of these, only about 5 percent have type 1 diabetes in which the body is born without the ability to produce insulin which is a chemical essential for regulating blood sugar levels.

Type 2 diabetes is much more common and is often related to over-consumption of sugar which, in turn, desensitizes cells to insulin. This means that our cells are incapable of accepting sugar from the surrounding blood leading to higher blood glucose levels.

Over time, this elevated blood sugar can damage nerve cells and produce a condition known as diabetic neuropathy. Diabetic neuropathy is often characterized by pain or numbness, especially in the legs and feet. As many as 50 percent of all diabetics may suffer from diabetic neuropathy.

A Closer Look at Diabetic Neuropathy

There are four kinds of diabetic neuropathy:

1. Peripheral neuropathy—this is the most common form of diabetic neuropathy and affects the legs and feet, followed by the hands and arms. Symptoms may include
   1. Numbness
   1. Tingling or burning sensation
   1. Cramps or sharp pains
   1. Muscle weakness
   1. Extreme sensitivity to touch
   1. Severe foot problems
2. Autonomic neuropathy—the autonomic nervous system may be affected.
   1. Fainting or dizziness due to blood pressure drops
   1. Bowel or bladder issues
   1. Nausea, vomiting or loss of appetite due to slowed digestion
   1. Difficulty adjusting vision from near to far or light to dark
   1. Unregulated sweating
   1. Sexual performance issues
3. Proximal neuropathy—this kind of neuropathy affects the hips and legs but may spread to the abdomen or chest.
   1. Intense pain in the hips or thighs
   1. Flaccid or weak thigh muscles
   1. Abdominal or chest pain
   1. Problems standing from a seated position
4. Mononeuropathy—this kind of neuropathy involves damage to only a single nerve, possibly in the face, torso, or limb.
   1. Double vision or inability to focus visually
   1. Facial paralysis on one side
   1. Tingling or numbness in the hands
   1. Weakness of the hands
   1. Pain originating in the shin or foot
   1. Problems lifting the front of the foot

Common Therapies for Diabetic Neuropathy

Diabetic neuropathy can be treated with many conventional therapeutic options, including

• Prescription medications—there are many drugs that can be used to slow the progress of the condition as well as mitigate symptoms. Anti-seizure medications may be used to soother overactive nerves and relieve pain. Similarly, tricyclic antidepressants may be used to manage pain as well as mental health issues.
• OTC pain reliever—many people use over-the-counter drugs like Tylenol or Capsaicin to help manage pain symptoms. Check with your doctor before taking an OTC medication as some may have serious risks.
• Diet—maintaining a healthy blood sugar level is essential for managing diabetic neuropathy, so closely monitoring glucose levels, especially around meals is very important. Proper diet may also help with gastrointestinal issues related to the diabetic neuropathy including diarrhea or constipation.
• Home remedies for pain—some people respond positively to at-home pain treatments like ice and heat, massage, or baths. It may be necessary to adjust your clothing if certain fabrics are causing pain.
• Surgical procedures—a procedure may be necessary if a serious health condition develops because of the diabetic neuropathy. If, for example, a major foot ulcer develops, then surgery to correct it may be necessary. One of the more common surgeries for neuropathic patients is nerve decompression surgery; this procedure alleviates pressure on a nerve by cutting ligaments pressing on the nerve.

Spinal Cord Stimulation

One therapy for diabetic neuropathy has become quite popular due to its relatively high success rate: spinal cord stimulation. Spinal cord stimulation is a minimally invasive procedure in which a pulse generator is implanted near the spine. The generator produces a mild electrical current that disrupts nearby spinal nerves from conducting pain signals to the brain.

Two major health care product manufacturers have developed SCS devices that have proven quite effective at managing diabetic neuropathy pain. Medtronic recently obtained FDA approval for its Intellis and Vanta technologies.

Intellis is a neurostimulator that provides higher intensity electrical stimulation but must be wirelessly recharged periodically. Vanta, on the other hand, does not require recharging because it delivers weaker electrical pulses for years.

Both neurostimulation systems have been clinically studied. In the first study, 60 patients with painful diabetic neuropathy in the legs were randomly implanted with an SCS device or chosen as a control. The SCS group dropped from an average pain score of 73 to 31 after six months following the procedure, while the control group maintained a steady 67.

Another study included 22 patients with diabetic neuropathy of which 17 underwent SCS implantation. After 24 months following the procedure, 14 of those who had the procedure reported at least a 50 percent reduction in pain severity.

The other major neurostimulation technology is the HFX system from the health care company Nevro. The HFX system offers up to more than 10 years of battery life while still providing a wide range of high or low frequency waveform currents. The HFX spinal cord stimulator also features 10 kHz therapy unlike other SCS devices which has proven more effective in mitigating diabetic neuropathy symptoms.

The HFX system offers unprecedented customizability that enables it to remain functional even in situations in which other SCS systems must be turned off including while sleeping or driving a vehicle.

Not everyone is a good candidate for a spinal cord stimulator. Patients who do not experience any pain relief during the initial SCS trial period should not consider one of these systems as treatment options. Patients who cannot tolerate minor surgical procedures or lacks the cognitive ability to properly manage a sophisticated technological device also may not be viable candidates.

You should consult with your physician or a pain specialist before choosing to undergo a neurostimulation procedure. Also, keep in mind that there may be a need for additional procedures at some point in the future.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA, and you should not post any of your private health information.