Introduction
Let us first understand what is “Pain”
Pain as an unpleasant bodily and emotional experience related with actual or potential tissue damage.
Pain is not just a physical feeling. Acute pain continues for a short time and occurs following surgery or trauma or other condition.
Pain is usually categorised by the kind of damage that causes in our body.
There are two types of pain which are common:
- Pain caused by tissue damage – Nociceptive pain
- pain caused by nerve damage – Neuropathic pain
Their differentiation is based on causes and presentations. Their treatment also differs substantially.
Neuropathic Pain
Neuropathic pain is a pain produced when there is some sort of damage of nervous system. The damage may happen at local level – peripheral nervous system or at central nervous system level.
Some people may experience a stabbing pain in the middle of the night and some other people may have symptoms of a chronic prickling, tingling, or burning that is felt all day. Uncontrolled nerve pain can be difficult to bear.
The quality of life (QoL) is highly affected by the associated physical and emotional distress apart from burden of Neuropathic pain,
The direct and indirect consequences of Neuropathic pain may include affect on the individual as well as the family and the society as a whole.
Neuropathic pain severity causes loss of productivity, many doctor visits and increased number of medications for treatment.
Diabetic Neuropathy
Diabetic neuropathy is the major type of neuropathy.
As per a recent report, the reported prevalence of diabetic peripheral neuropathy (DPN) in India was 29.2% in patients with type 2 diabetes mellitus (T2DM).
In Diabetes, the nerve damage caused is called as diabetic neuropathy. It is observed that high blood sugar (glucose) levels leads to injury of nerves throughout the body. Diabetic neuropathy commonly damages nerves in the legs and feet.
Based on the nerves damaged, diabetic neuropathy symptoms may range from pain and numbness in the legs and feet to problems with the digestive system, urinary tract, blood vessels and heart. In diabetic neuropathy, some people may have mild symptoms, whereas others may have quite painful and disabling symptoms.
It is found that diabetic neuropathy is a serious complication in as many as 50% of 50% of the people with diabetes. It is possible to prevent diabetic neuropathy in some people or slow the progress with proper management of blood sugar and adopting a healthy lifestyle.
Symptoms of diabetic neuropathy
Diabetic neuropathy has four main types. A diabetic can have one type or more than one type of neuropathy.
The symptoms will depend on the type of diabetic neuropathy and which nerves are affected in particular individual. It is observed that diabetic neuropathy symptoms develop slowly and gradually. You may not notice anything wrong until substantial nerve damage has happened.
1. Peripheral neuropathy
Damage to the nerves outside of the brain and spinal cord which are called peripheral nerves is called Peripheral neuropathy.
Amongst the diabetics, this is the most common type of diabetic neuropathy. It starts with the feet and legs, subsequently affects the hands and arms. The
signs and symptoms of peripheral neuropathy may often become worse during the nights, and may include:
- Numbness in certain parts of body or loss or reduced ability to feel pain or temperature changes
- Tingling sensation or burning feeling in the body parts affected
- Sudden sharp pains or cramps
- High sensitivity to touch — some people may experience pain even with bedsheet’s weight
- Serious foot issues, like ulcers, infections, bone and joint pain
2. Autonomic neuropathy
The autonomic nervous system controls body parts like heart, urinary bladder,
stomach, intestines, sex organs and eyes.
Diabetes may affect nerves in any of these areas leading to:
- A lack of awareness that blood sugar levels are low and fluctuating
- Urinary Bladder or bowel difficulties
- Reduced stoma emptying, causing nausea, vomiting and loss of appetite
- Changes in the way the eyes adjust change from light to dark
- Decreased sexual response
3. Proximal neuropathy (diabetic polyradiculopathy)
It mainly affects nerves in the thighs, hips, buttocks or legs. It can also affect the areas in the abdomen and chest.
You may experience symptoms on one side of the body, and may spread to the other side.
The symptoms may include:
- Severe pain felt in the hip, thigh or buttock
- Subsequent weak and lessening thigh muscles
- Difficult to rise from sitting position
- Severe stomach ache
4. Mononeuropathy (focal neuropathy)
Mononeuropathy refers to damage to a particular nerve.
Mononeuropathy can be of two types — cranial and peripheral.
The symptoms of mononeuropathy could be:
- Difficulty to focus or having double vision
- Pain behind one eye
- There may be paralysis on one side of the face (Bell’s palsy)
- Numbness or tingling sensation the hands or fingers, except little finger
- Weakness in the hands which may cause one to drop things
See a doctor when,
- You have a cut or pain on your foot that is infected or not healing
- You experience burning, tingling, or weakness or pain in the hands or the feet which may be interfering with daily activities or sleep
- You observe changes in digestion, urination or sexual function
- You sometimes experience dizziness and fainting