Dr Darren’s Thursday surgery
Q: I read with interest about deep vein thrombosis in a previous column. I am a 61-year-old female and have been a type 2 diabetic for 10 years.
I suffer from burning, aching feet and lower legs, and the condition is particularly bad when I lie down. In fact the sensation varies between burning, tearing and a shooting electric shock.
I am able to wear different types of shoes and can walk long distances as being up and about eases the discomfort somewhat; but the daily pain doesn’t go away.
I have in the past (on two occasions) seen a vascular surgeon who told me the blood circulation/pulses in my legs were normal. A physician once prescribed Lyrica capsules, but this definitely did not ease the pain. In fact, it made me feel like a zombie
A: The description sounds almost characteristic of neuropathic pain (nerve tissue pain).
The truth is that it is not an easy condition to treat. Damage to nerve tissue can be viewed in two main groups: disease affecting the jellylike insulating layer surrounding certain nerve cells or neurons, or a process affecting the nerve axon itself. The most likely process leading to your pain is damage to the long peripheral nerves of the lower leg. Peripheral neuropathy can be extremely painful.
Your best advice at this stage is excellent diabetic control, regular exercise, aspirin, nutritional supplementation of B vitamins – especially B12 – and no alcohol.
Pain control is best achieved by drugs directed at altering the nerve conduction thresholds – working on the cell receptors or ion channels which carry electric impulses.
Anti-epileptic drugs work on the sodium and potassium channels too.
The best known treatments for diabetic sensory neuropathy include Amytriptilline, Carbamazepine, Gabapentin and even Phenytoin.
It is crucially important to note that despite pulses all being present and palpable, the microvascular complications of diabetes are silent killers.
Optimal sugar control and excellent compliance with meds, as well as lifestyle modification, is the only hope of halting further damage. The degree to which existing damage is reversible depends on the extent of damage, duration of the disease and the patient’s other illnesses.