Subject: Healthy-nerves shouldn't feel like pins-and-needles

From: Douglas <[email-masked]>
Date: Fri, 23 Feb 2018 17:03:48 -0500

Neuropathy-Newsletter No. 6439534
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You shouldn't have to live with this-pain
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Attn: [email-masked],

Neuropathy-is typical brought on by-diabetes, and can cause-pain, a "numb" or "loose" sensation, can effect your-equilibrium and more, and it can be quite-difficult to live with. 

But this doesn't mean you should just give-up and suffer-with it!

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The patient may be advised to rest and to use heat and a limited course of drugs to reduce inflammation. In carpal tunnel syndrome, conservative therapy includes splinting the wrist, oral or injected corticosteroid drugs, and ultrasound. If a single-nerve neuropathy does not respond to these measures, surgery may be an option. Surgery may also be necessary if the nerve compression is fixed, for example when caused by a tumor. Referral to specialist pain services 14721295or a relevant clinical specialty should be considered at any stage if: pain is severe pain significantly limits daily activities and quality of life an underlying health condition is getting worse Symptoms vary according to the types of neuropathy. Sensory neuropathy The person may have: The most common cause of peripheral neuropathy is diabetes. Around 60 to 70 percent of people with diabetes have some degree of neuropathy. High blood sugar levels cause damage to the walls of the tiny blood vessels that supply oxygen
  and nutrients to the nerves in the ends of the hands and feet, and the essential organs in the body, such as the eyes, kidneys, and heart.

This article focuses on the epidemiology and pathogenesis as well as clinical features, diagnosis, and management of DPN, the most common form of diabetic neuropathy. Defining Diabetic Neuropathy Diabetic neuropathy usually has a long subclinical latency period whose identification and management are challenging. It is 4944important, however, to identify neuropathy in its earliest stages to prevent the extreme morbidity and healthcare costs associated with its progression. Traditionally, diabetic neuropathy has been defined as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after excluding other causes.2 In 2009, preceding the joint meeting of the 19th Annual Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes (NEURODIAB) and the Eighth International Symposium on Diabetic Neuropathy in Toronto, a panel of experts convened to provide updates on classification, definitions, diagnostic criteria, and treatmen
 ts of DPN The epidemiology of diabetic neuro-pathy depends on the case definitions used. If presence of symptoms was used as a criterion, 10% to 15% of diabetic patients would have neuropathy. The prevalence increases to 50% when sensory testing and nerve conduction study criteria are included.

been seen by a neurologist and endocrinologist, and has excellent control over his diabetes. Instead of pregabalin, I would prescribe gabapentin/enacarbil (Horizant) off label at the highest recommended dose of 600 mg bid. In my experience with the extended-release formula, I can prescribe a lower dose of the medication and get a similar effect as that of high-dose pregabalin but with less side effects (weight gain and edema), which can be a problem for patients with diabetes.1 I would continue the patient on duloxetine, as prescribed. Other clinicians might consider dorsal column stimulation. 85181However, a recent article in The Wall Street Journal, raised several issues regarding the treatment.2 The FDA database contains 58 unique reports of paralysis associated with spinal cord stimulators (SCS) in 2013, compared with 48 reported incidences of paralysis in 2012. Researchers at Duke University found that nearly 1 patient in every 100 who received a SCS experienced some degree of s
 pinal cord or spinal nerve root damage.3 This study involved records of more than 12,300 SCS patients. In addition, the complication rates can be between 25% and 35%.