Sometimes my feet will hurt really badly and I can’t get up and can hardly walk. — Anonymous patient
Having such intractable pain has devastating consequences for quality of life.
Pain sufferers have less social interaction with family and friends, and find it much more difficult to enjoy their favourite activities. Sleep is significantly disrupted.
Having neuropathic pain is associated with high rates of anxiety and depression. To make matters worse, the sleep disruption, anxiety and depression may feed back into a vicious cycle to worsen and maintain the pain.
There are days when I’d really like to go somewhere or do something and just don’t go. I know it will hurt. There’s no point in doing it. — Anonymous patient
Medications to manage the pain
Neuropathic pain is not responsive to the medications used to treat conditions such as headaches and joint pains (for example, paracetamol and ibuprofen).
Instead, neuropathic pain is responsive to medications that in some cases are also used to treat conditions such as depression and epilepsy.
Examples include:
low doses of tricyclic antidepressants (for example,amitriptyline)
a class of antidepressants called serotonin and noradrenaline re-uptake inhibitors (for example,duloxetine)
anti-seizure drugs like gabapentinoids (for example,gabapentin andpregabalin).
However, there is very little information to guide doctors topredict which drug will work best for a patient.
So often finding the correct treatment is atrial-and-error approach, which can be frustrating for both patients and doctors.
Coping mechanisms
Chronic pain management is also about teaching people to cope with their pain so that they get back to enjoying their lives and are no longer consumed by the pain.
Such interventions include the practice of mindfulness, cognitive behavioural therapy, and other self-management activities specificallydesigned for people with chronic pain.
With the rapidly growing number of individuals with diabetes, it is more important than ever that we detect and treat the pain caused by nerve fibre damage.
Public education and increased awareness of this painful consequence of diabetes will hopefully encourage affected people to seek early medical attention, thus allowing management of the condition, maintaining wellbeing and restoring function.
• Peter Kamerman: professor, University of the Witwatersrand
• Andreas C Themistocleous: clinical lecturer in neurophysiology, University of Oxford
This article was first published by The Conversation