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What is Diabetic Neuropathy?

Reviewed by Dr. Nileshkumar Patel, M.D., M.B.A.

Diabetic neuropathy is a painful condition caused by nerve damage from diabetes. The damage can occur throughout the body, but is most common in the legs, feet and hands and can lead to symptoms of burning pain and numbness.1

Diabetes leads to high levels of blood glucose (commonly known as blood sugar), and prolonged elevation of blood glucose is believed to cause nerve damage. Over time, this can cause numbness, tingling, and pain, especially in the extremities. As many as half of all adults with diabetes may develop diabetic neuropathy during their lifetime.2,3

What are the different types of Diabetic Neuropathy?

There are three main types of diabetic neuropathy, affecting different parts of the body, each with distinct clinical impacts. 

Symmetrical Peripheral Neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy. It usually affects the feet and legs first, and symptoms may begin with a loss of sensation. Pain and discomfort in the feet are common and may feel like tingling or burning, or a sharp, jabbing pain. Diabetic foot pain can be so severe that even the lightest touch can be hard to tolerate.

Autonomic Neuropathy

Autonomic neuropathy affects the nervous system that controls automatic body functions – including, for example, your heartbeat, breathing, and digestion. As you may expect, symptoms might include digestive problems, dizziness from blood pressure issues, loss of bladder control, and sweating problems.

Focal Neuropathy

Focal neuropathy (also called mononeuropathy) is damage to a single nerve, which can be in any part of the body, including the face. Symptoms can include numbness or tingling, weakness in hands making it difficult to hold things, foot pain, and paralysis on the side of the face.

Who is most likely to get Diabetic Neuropathy?

Anyone diagnosed with diabetes is at risk of developing diabetic neuropathy. To lower your risk, you should practice good blood sugar management and adopt a lifestyle that includes frequent exercise, weight management. and a healthy diet.

What are common treatments for Diabetic Neuropathy?

Because there is no cure for diabetic neuropathy, the American Diabetic Association (ADA) recommends tight glucose control as the primary method for preventing or slowing down the progression of the condition, relieving diabetic pain and discomfort, and managing complications. The FDA has approved duloxetine, pregabalin, and tapentadol as oral agents, and capsaicin patches for topical application, but the ADA does not recommend tapentadol as it has weak opioid activity.5 Unfortunately, not everyone responds to these drugs and many people find the side-effects hard to tolerate for sustained periods of time. The reality for most diabetic neuropathy patients is that there is tremendous pain, suffering, and functional impairment, calling for new approaches to treating diabetes.6

Diabetic Peripheral Neuropathy and Spinal Cord Stimulation

An encouraging recent development for patients with Diabetic Peripheral Neuropathy (DPN) is that Spinal Cord Stimulation (SCS) has now been approved by the FDA as a treatment to relieve the pain they may be experiencing in the lower legs and feet.*

SCS therapy uses a small, implanted device that delivers mild electrical pulses to interrupt pain signals coming from the affected part of the body. Boston Scientific’s SCS therapy has provided significant, lasting relief from neuropathic pain for more than 20 years. And in a recent clinical study spanning three years, 90% of DPN patients reported sustained improvement with Boston Scientific’s SCS therapy.4

SCS therapy is fully reversible and patients can take a trial first to see if it works for their particular pain.

This short video explains how SCS works:

Key Points

  • Diabetic neuropathy is a serious condition affecting many people living with diabetes.

  • There are three main types of diabetic neuropathy – Autonomic, Focal, and Peripheral.

  • Careful blood sugar management, diet, and exercise may help avoid or delay the progression of diabetic neuropathy.

  • People living with Diabetic Peripheral Neuropathy (DPN) now have the option of SCS therapy to help manage the pain and discomfort they may feel in their lower extremities. 

Next steps

Only a pain management specialist can help you determine if SCS may be right for your specific pain. If you have been diagnosed with DPN, you can learn more about SCS for DPN here or you can call to speak to one of our Patient Education Specialists at 877.473.0844, 5:30am – 5pm PT, M-F. They can connect you to doctors in your community with the expertise to discuss if SCS therapy is appropriate for you.

Wondering if Spinal Cord Stimulation may be right for you?

Take this quick quiz and find out. ⟶

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References:

* Only paresthesia-based stimulation mode has been evaluated for effectiveness in the diabetic peripheral neuropathy (DPN) population.

1. Mayo Clinic. Diabetic neuropathy symptoms. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580. Accessed October 5, 2023.

2. American Diabetes Association. Statistics about diabetes. https://diabetes.org/about-diabetes/statistics/about-diabetes Accessed October 8, 2023.

3. Hicks, C.W., Selvin, E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep 19, 86 (2019). https://doi.org/10.1007/s11892-019-1212-8

4. Chaiban G, et al. Real-World Outcomes in PatientsUsing SCS for Treatment of Painful Diabetic Peripheral Neuropathy (DPN) [Abstract]. Twenty-sixth Annual Meeting of the North American Neuromodulation Society, January 13-15th, 2023. (n=24 @ 1 year, n=16 @ 2 years, & n=12 @ 3 years, Ongoing study)

5. Pop-Busui R, Ang L, Boulton AJM, Feldman EL, Marcus RL, Mizokami-Stout K, Singleton JR, Ziegler D. Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy. Arlington (VA): American Diabetes Association; 2022 Feb. PMID: 35544662

6. Yeung AM, Huang J, Nguyen KT, Xu NY, Hughes LT, Agrawal BK, Ejskjaer N, Klonoff DC. Painful Diabetic Neuropathy: The Need for New Approaches. J Diabetes Sci Technol. 2022 Oct 28:19322968221132252.

 

Indications for Use: The Boston Scientific Spinal Cord Stimulator Systems are indicated as an aid in the management of chronic intractable pain of the trunk and/or limbs including unilateral or bilateral pain associated with the following: failed back surgery syndrome, Complex Regional Pain Syndrome (CRPS) Types I and II, intractable low back pain and leg pain, Diabetic Peripheral Neuropathy of the lower extremities, radicular pain syndrome, radiculopathies resulting in pain secondary to failed back syndrome or herniated disc, epidural fibrosis, degenerative disc disease (herniated disc pain refractory to conservative and surgical interventions), arachnoiditis, multiple back surgeries. The Boston Scientific Spectra WaveWriter™, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems are also indicated as an aid in the management of chronic intractable unilateral or bilateral low back and leg pain without prior back surgery.

Contraindications. The Spinal Cord Stimulator systems are not for patients who are unable to operate the system, have failed trial stimulation by failing to receive effective pain relief, are poor surgical candidates, or are pregnant.

MR Conditional symbol

Boston Scientific’s ImageReady™ MRI Technology makes safe MRI head scans possible. Patients implanted with the Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems with ImageReady™ MRI Technology are "MR Conditional" only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Head Only Guidelines for Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems.

MR Conditional symbolBoston Scientific’s ImageReady™ MRI Full Body Technology makes safe MRI scans possible. The Precision Montage™ MRI, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems with ImageReady™ MRI Full Body Technology are “MR Conditional” only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Full Body Guidelines for Precision Montage™ MRI or WaveWriter Alpha™ and WaveWriter Alpha™ Prime Spinal Cord Stimulator Systems.

Warnings. Patients implanted with Boston Scientific Spinal Cord Stimulator Systems without ImageReady™ MRI Technology should not be exposed to Magnetic Resonance Imaging (MRI). Exposure to MRI may result in dislodgement of the stimulator or leads, heating of the stimulator, severe damage to the stimulator electronics and an uncomfortable or jolting sensation. As a Spinal Cord Stimulation patient, you should not have diathermy as either a treatment for a medical condition or as part of a surgical procedure. Strong electromagnetic fields, such as power generators or theft detection systems, can potentially turn the stimulator off, or cause uncomfortable jolting stimulation. The system should not be charged while sleeping. The Spinal Cord Stimulator system may interfere with the operation of implanted sensing stimulators such as pacemakers or implanted cardiac defibrillators. Advise your physician that you have a Spinal Cord Stimulator before going through with other implantable device therapies so that medical decisions can be made and appropriate safety measures taken. Patients using therapy that generates paresthesia should not operate motorized vehicles such as automobiles or potentially dangerous machinery and equipment with the stimulation on. Stimulation must be turned off first in such cases. For therapy that does not generate paresthesia (i.e. subperception therapy) it is less likely that sudden stimulation changes resulting in distraction could occur while having stimulation on when operating moving vehicles, machinery, and equipment. Your doctor may be able to provide additional information on the Boston Scientific Spinal Cord Stimulator systems.  For complete indications for use, contraindications, warnings, precautions, and side effects, call 866.360.4747 or visit Pain.com. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Superion™ Indirect Decompression System (IDS) is indicated to treat skeletally mature patients suffering from pain, numbness, and/or cramping in the legs (neurogenic intermittent claudication) secondary to a diagnosis of moderate degenerative lumbar spinal stenosis, with or without Grade 1 spondylolisthesis, having radiographic evidence of thickened ligamentum flavum, narrowed lateral recess, and/or central canal or foraminal narrowing. The Superion™ Interspinous Spacer is indicated for those patients with impaired physical function who experience relief in flexion from symptoms of leg/buttock/groin pain, with or without back pain, who have undergone at least 6 months of non-operative treatment. The Superion Interspinous Spacer may be implanted at one or two adjacent lumbar levels in patients in whom treatment is indicated at no more than two levels, from L1 to L5. Contraindications, warnings, precautions, side effects. The Superion Indirect Decompression System (IDS) is contraindicated for patients who: have spinal anatomy that prevent implantation of the device or cause the device to be unstable in situ (i.e., degenerative spondylolisthesis greater than grade 1), Cauda equina syndrome, or prior decompression or fusion at the index level, scoliosis or spinous process fractures, osteoporosis, infection, allergy or reaction to any metal or implant or a high Body Mass Index. Avoid strenuous activity for 6 weeks after surgery, contact your physician if there is fluid leaking from your incision, if you have pain, swelling or numbness in your legs or buttocks or if you fall. Refer to the Instructions for Use provided on www.vertiflex.com for additional Indications for Use, contraindications information and potential adverse effects, warnings, and precautions prior to using this product. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Boston Scientific Radiofrequency Generators, associated Radiofrequency Lesion Probes and RF Cannula are indicated for use in procedures to create radiofrequency lesions for the treatment of pain or for lesioning nerve tissue for functional neurosurgical procedures. The Boston Scientific RF Injection Electrodes are used for percutaneous nerve blocks with local anesthetic solution for radiofrequency lesioning of peripheral nerve tissue only. The Boston Scientific LCED and Stereotactic TCD Electrodes are indicated for use in radiofrequency (RF) heat lesioning of nervous tissue including the Central Nervous System.

Warnings: The Boston Scientific RF devices may cause interference with active devices such as neurostimulators, cardiac pacemakers, and defibrillators. Interference may affect the action of these active devices or may damage them. For appropriate guidance, consult the instructions for use for these active devices. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

§The physician locator tool identifies pain management specialists in your area who have met certain qualifying criteria and are experienced with one or more of Boston Scientific pain management therapies. All treatment options should be discussed thoroughly with a pain management specialist.