Painful Diabetic Neuropathy: Understanding and Treating Nerve Pain

Diabetes can affect many parts of the body, including the nerves. Over time, elevated blood sugar can damage peripheral nerves, leading to a condition known as diabetic neuropathy.

For some people, diabetic neuropathy causes numbness or tingling. For others, it can produce significant burning, stabbing, or electric-like pain that interferes with walking, sleep, and everyday activities.

While nerve damage cannot always be reversed, there are several ways to manage the symptoms—and newer treatment options may provide relief when medications and conservative treatments aren't enough.

What Does Diabetic Neuropathy Feel Like?

The most common form is diabetic peripheral neuropathy, which typically begins in the feet and may gradually progress upward.

Symptoms may include:

• Burning or shooting pain
• Tingling or "pins and needles"
• Electric or stabbing sensations
• Increased sensitivity to touch
• Numbness or decreased sensation
• Symptoms that are worse at night
• Balance difficulties

Symptoms often affect both feet and may eventually involve the lower legs or hands.

Loss of sensation is particularly important because injuries, blisters, or sores may go unnoticed. Regular foot examinations are an important part of diabetes care.

Why Does Diabetes Damage the Nerves?

Persistently elevated blood glucose can damage nerves and the small blood vessels that supply them. The risk of neuropathy generally increases with the duration of diabetes and with poorer glucose control.

Other factors—including kidney disease, smoking, elevated cholesterol or triglycerides, and cardiovascular risk factors—may also contribute.

Maintaining good diabetes control is therefore an important part of preventing or slowing progression of diabetic neuropathy.

How Is Diabetic Neuropathy Diagnosed?

Diagnosis typically begins with a medical history and physical examination. Your provider may evaluate sensation, strength, reflexes, balance, and the health of your feet.

Sometimes additional testing, such as nerve conduction studies, electromyography (EMG), or laboratory testing, is appropriate—particularly when symptoms are unusual or another cause of neuropathy is suspected.

Not everyone with diabetes and foot pain has diabetic neuropathy. Other conditions such as lumbar radiculopathy, peripheral vascular disease, vitamin deficiencies, nerve entrapment, or other forms of peripheral neuropathy can produce similar symptoms.

How Is Painful Diabetic Neuropathy Treated?

Treatment usually involves two goals: protecting the nerves from further damage and controlling painful symptoms.

Good blood sugar management remains an important part of treatment. Exercise, appropriate nutrition, weight management, smoking cessation, and management of other cardiovascular risk factors may also be beneficial.

For painful symptoms, medications may include drugs such as duloxetine, pregabalin, or gabapentin. Certain topical medications may also be appropriate.

Unfortunately, some patients continue to experience significant pain despite medications and other conservative treatments.

What If Medications Aren't Providing Enough Relief?

For patients with painful diabetic neuropathy that remains difficult to control, spinal cord stimulation may be an option.

Spinal cord stimulation (SCS) uses small electrodes placed in the epidural space near the spinal cord to modify pain signals before they reach the brain. The electrodes are connected to a small implanted device that generates electrical stimulation.

Importantly, patients generally undergo a temporary trial first. This allows them to experience the therapy and determine whether it provides meaningful relief before deciding whether to proceed with a permanent implant.

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Spinal cord stimulation has traditionally been used for conditions such as chronic back and leg pain, but clinical research has also demonstrated significant benefit in appropriately selected patients with refractory painful diabetic neuropathy.

In the randomized SENZA-PDN trial, patients receiving 10-kHz spinal cord stimulation plus conventional medical management experienced substantially greater pain relief than those receiving conventional medical management alone. Longer-term follow-up has demonstrated sustained benefit in many patients.

Spinal cord stimulation does not cure diabetes or eliminate the underlying cause of neuropathy. Instead, its purpose is to reduce the painful signals associated with nerve damage and improve function and quality of life.

Is Spinal Cord Stimulation Right for Everyone?

No. SCS is generally considered after more conservative treatments have been tried without adequate relief.

Evaluation may include reviewing:

• The pattern and severity of neuropathic pain
• Previous medications and treatments
• Diabetes control
• Overall medical health
• Psychological and behavioral factors
• Ability to safely undergo the procedure
• Expectations and treatment goals

Because diabetes can increase the risk of infection and impaired wound healing, appropriate patient selection and diabetes management are particularly important when considering an implanted device.

When Should You Consider Seeing a Pain Specialist?

If diabetic neuropathy is causing persistent burning, shooting, or electric-like pain despite medications and appropriate diabetes management, additional treatment options may be available.

At Deseret Rock Pain Specialists, we evaluate patients with chronic neuropathic pain and help determine whether additional treatments—including spinal cord stimulation—may be appropriate.

For the right patient, the goal isn't simply to lower a pain score. It's to help improve sleep, walking, activity, and quality of life while reducing the impact that painful diabetic neuropathy has on everyday life.